Nonfiction

The Knitter, pen and pastels, drawing by Carolyn Schlam

Socks for Lola

Yesterday as I was preparing to knit my first pair of socks since the pandemic began—my mind wandering as I measured a length of yarn for the cast-on—I suddenly realized:  my friend Lola is dying. These socks must be for her.

 

With renewed urgency, I caressed the soft balls of yarn, hoping she’d like my selection—a combination of light green, darker green, and lavender light-fingering merino yarn. Then I began the tedious task of the long-tail cast on, rotating the strands of yarn in my left hand while the right-hand needle danced through the loops of yarn.

I was determined to finish the socks in time.

Lola was diagnosed with ovarian cancer one October morning, which now feels like a decade ago.  As is frequently the case with ovarian cancer, her disease was already widespread. She had noticed vague symptoms, easily explained by overexertion and work travel, until she developed what she thought was a skin infection around her umbilicus—a swollen, tender redness—which she attributed to swimming in the lake at her family’s summer home.

She called me early one morning to ask where she should go to have her skin infection evaluated and treated. She was so healthy she didn’t have a primary care physician and, being European, had little experience with American medicine beyond taking her children for routine visits to the pediatrician. I recommended an emergency room in the medical center and gave her the name of a surgeon there, in case the abscess needed surgical drainage.

Two hours later, Lola texted me that she had just been diagnosed with ovarian cancer. I took a deep breath and quietly cursed. This can’t be happening, I thought. What an awful disease…and her kids are too young to lose their mother.

***

I’ve been knitting since childhood, starting off with making shawls for my Barbie dolls, advancing to knitting a burgundy wool sweater I never finished. Then I gave up knitting until, decades later, work stress led me to take it up again for its calming effect. Mostly I made blankets for my medical trainees having their first babies; then I made baby sweaters. Several years ago, I started knitting socks—for the challenge and because they are such a portable project for road trips or airplane flights. I cast on sixty-four stitches for each sock—a magic number, apparently—divided on two short circular needles so I can knit both socks at once. This method was the ingenious invention of some clever knitter, a way to protect distractible people like me from the well-described “second sock syndrome,” the inability to start or complete the second sock to make a matching pair.

I began knitting Lola’s socks at the cuff, the backbone of the sock, which sets the tone for both the fit and the design. The cuff must be tight enough to stay up and loose enough to prevent marks on the wearer’s calf. I wondered if I had too many stitches: would the socks stay up on Lola’s legs after she’s lost even more weight?

***

Lola has been a friend since graduate school, one of a group of women who’ve stayed close since graduation; we gather at someone’s house every couple of months for dinner and raucous laughter. She is tall and thin, the quietest one in our group, passionate about travel, a gifted photographer, driven in her profession. As this saga unfolded, Lola saw oncologists at the original hospital who mapped out a plan for chemotherapy followed by surgery. She and her husband, Matt, leaned on my husband Jay and me a great deal in those early days. Jay offered to sequence her tumor’s DNA so that her chemotherapy could be tailored to the tumor. I encouraged her to get a second opinion at our local cancer hospital, the country’s number one oncology specialty center. “Why wouldn’t you?” I asked. “People come from all around the world for care here, and it’s only a twenty-minute drive from your house.”

Lola visited the cancer center, liked their team’s approach, and transferred her care there.  She managed her chemotherapy with aplomb, continuing her position as vice president of a major energy company’s mergers and acquisition group, despite all-day weekly chemotherapy sessions. She wore exercise clothes to the hospital, took long walks in the medical center during waiting periods and downtime between medications, and hosted meetings with her work team while she was tethered to the chemotherapy pump. Even after months of chemotherapy, Lola tolerated major abdominal surgery well, too, showing the same energy and commitment to regaining her strength and stamina, patrolling the hospital corridors for hours. After recovering from the surgery, she continued chemotherapy without complaint. When she developed a worrisome liver inflammation, a not-unexpected side effect of her chemotherapy that kept her hospitalized for weeks, Lola decided the chemo was killing her and stopped going to the clinic. She told her oncologist she wanted to try managing her disease by natural means. That’s when things got a little weird.

Lola had always lived a healthful lifestyle. She cooked nutritious meals for her family—roasted salmon with vegetables was one of her signature dishes—and maintained a rigorous exercise regimen: two hours in the neighborhood gym each night after her kids went to bed. She was also an accomplished skier; I remember the winter she and her husband helicoptered into wilderness territory to experience ungroomed trails and fresh powder snow.

After Lola stopped visiting the clinic, she and her husband became obsessed with the medicinal properties of food. They claimed they had done research on which foods to eat and which to eliminate to cure her cancer “definitively.” I bit my tongue to avoid lecturing about the difference between Googling something and performing true research. Both Lola and Matt lost weight, and neither had weight to lose.

She began getting vitamin C, selenium, and curcumin infusions, and for many months traveled every week to see a doctor in Tijuana, Mexico, who gave her “special chemotherapy.”  Lola didn’t seem to know too much about what was in his cocktail, but she told me she liked the way he held her hand while he talked to her. She invested in advanced meditation classes and spent hours each day in prayer. She began deflecting questions about her condition with our tight-knit group, telling us she wanted to avoid entertaining negative thoughts—even for a moment—because those thoughts might revive her cancer. At one of our frequent dinners, each of us noticed that Lola’s abdomen was noticeably distended, as if she were pregnant. Every other person at the table offered life and work updates; but Lola reported nothing about her cancer or treatment. Though we were all worried about her, we had always accepted what each person chose to share, without prying further. And Lola has always been the quietest, most private person in our group.

It’s been hard for me to sit back and watch Lola make the choices she’s made.  Obviously, I grant her the same autonomy over her body that I demand for myself. She’s an incredibly smart person, skilled at making high-stakes, data-driven analytical decisions, so her wanderings into unproven medicine seem out of character. Are they based on fear or hope—or perhaps on the innocence of never having had any exposure to friends or family members who have struggled with chemotherapy? I asked her once if she ever wondered why the cancer center did not offer curcumin infusions if they were so effective against her cancer. “Why would they withhold a treatment from you that would cure this cancer?”

No response.  None.  Her body still, she looked away.

To be clear: I’m not opposed to the incorporation of alternative treatments into the management of cancer. In fact, all the major cancer centers have whole sections on integrative medicine, combining traditional cultural treatments, plant-based medications, and mind-body treatments with standard chemotherapy. They pour millions of research dollars into scientific studies to determine which of these alternative treatments might show positive results. I also firmly support the incorporation of mind-body treatments and counseling to help patients cope with the stresses of their illness. A paradigm combining psychosocial support, meditation, nutrition, and exercise with disease-directed chemotherapy, delivered by an integrated team, seems ideal to me. But to walk away completely from treatments scientifically proven to extend survival? That decision was hard for me to swallow. And I worried about what would happen next for Lola.

***

It took me more than a week to finish knitting the leg of the socks: the cuff to hold it up, and a simple decorative design moving down toward the ankle. Knitting the leg—a tube—has always reminded me of how our hearts form from a muscular tube early in embryonal development, folding into just the right configuration of four chambers in series, a miraculous contortion in response to unseen messages.

Finally, it was time to turn the heel, the part of sock-knitting where the magic happens. I hold the needles and yarn closer to my chest so I can easily see the special “twin” stitches that form the heel: this physical closeness creates a special intimacy. I sit on my sofa, knitting back and forth, row after row on two pointed needles no thicker than spaghetti. Then, suddenly, voila!  A graceful cup shape, smaller than a cardinal’s nest, emerges from between my needles. It will embrace a rounded pink heel, the hard-charging, weight-bearing bone that marks the beginning of each step. In turning the heel, the sock rounds a literal and figurative corner, slinking into the dark recesses of the shoe.

***

Lola’s life has turned a corner, too. When the border to Mexico closed during the pandemic, she resumed standard chemotherapy, in reduced doses that she negotiated with her oncologist. But despite everyone’s efforts, her tumors have grown with a vengeance. Does she understand what it means for her tumors to grow while she’s on chemotherapy? Now with multiple intra-abdominal tumors, ascites (fluid in her abdomen) requiring a drain, a recent hospitalization for small bowel obstruction, the trajectory of her illness could not be clearer—to me. Has her oncologist had the “Difficult Conversation” with Lola? I can only imagine how challenging those conversations have been during the pandemic, when spouses or supportive friends have not been allowed to accompany patients to their clinic appointments. Has her oncologist offered Lola the choice to stop chemotherapy and focus on the fullness of her remaining days? Has she suggested hospice care to help Lola focus on what is most important to her? I don’t know, because Lola still isn’t talking.  And it’s not my place to push her into saying more than she’s comfortable sharing.  I hope her medical team has been honest with her.

***

I feel a rhythm in sock knitting that, to me, seems strangely parallel to the cadence of our lives. At the beginning, there is excitement as the knitter selects the yarn and the pattern; there is optimism, the excitement of a of a fresh start, the desire to see how the design will reveal itself. Then comes a dash through the simple cuff, eagerness to begin the pattern of the leg. The rhythm slows just before the heels, which require solitude and the knitter’s undivided attention. Once they’re finished, the pace picks up again, continuing the decorative pattern on the top of the foot, a simple stockinette stitch on the bottom to caress her foot as she walks. Then, moving toward the finale of the toes, a languidness sets in again, as though to draw out the pleasure of the knitting, a reluctance to let go. I measure carefully to begin sculpting a gentle, rounded toe so she’ll have plenty of space for her long, narrow feet. With Lola’s socks, however, I work quickly. It iss important to finish them so her feet will be warm.

***

I’m worried that Lola will blame herself: for not meditating more, not having a stronger faith—not praying enough, not trying harder on her wellness regimen, not being even more rigorous with her diet. I fear her attitude toward her illness may be the same. I hear echoes of self-blame when she e-mails us about what she terms her “dis-ease” and clings to the notion that, if she works harder to control her mind and heart, her body will be able to eliminate the cancer on its own. This kind of self-punishment is the consequence of the battle metaphor so prevalent—and so destructive—in our discourse around cancer and other serious illnesses. That metaphor ignores the biology of cancer and our incomplete understanding of how and why certain cancers evade even aggressive and targeted chemotherapy. It’s time for Lola to give herself some grace.

***

I know where Lola’s path is headed. I am already feeling a heavy sadness, feeling the sense of dread breathing down the back of my neck. It’s hard to be the person who knows the end of the movie my friends haven’t seen yet. The end could come quickly for Lola with a sudden, overwhelming catastrophe—or she could suffer a long, slow decline. I wish I could see the trajectory of her path and could help her navigate the next part of her journey. I don’t know how Lola would articulate her hopes, but here are my own: I hope her caregivers will offer hospice treatment. I hope the hospice referral will come early enough that a compassionate team can assure her comfort and peace of mind. I hope she’ll accept their help, if only so her husband and children receive supportive and professional counseling before and after her death. I hope her reluctance to speak of her illness hasn’t extended to her children—that she has prepared them as best as she can. I hope her pain will be controlled, so she can face the end of her life with a sense of peace and grace.

***

Matt called me Monday morning, just as I was setting out on my hospice rounds. Lola was in the hospital again, this time with another bowel obstruction that cannot be fixed. There are no further chemotherapeutic options. Surgery is not possible. Her team will arrange to have a stomach tube placed so that she can drink and then drain her stomach contents back out again, just for comfort. She will not be receiving nutrition going forward. Her team’s social worker handed Matt a multi-page, single-spaced list of local hospice agencies from which to choose caregivers for Lola. “How am I supposed to choose one?” he asked me.

The cone of silence lowers over my head and shoulders as I enter this new space with Lola and Matt. Now I have a professional obligation to respect her privacy, not share her condition with our mutual friends, because Lola and Matt chose for her to receive care from the hospice where I work. My hospice co-workers have assumed responsibility to row Lola to the other side. I’ll stand to the side, ready to support or answer questions, hoping for updates, but I won’t be involved in her day-to-day care.

Cancer really sucks as a spectator sport.

***

The socks are washed and blocked into their final shape now, soft and fragrant with the scent of lavender soap. I wrap them in tissue paper.

***

Lola sends a long text to our group, letting us all know her cancer has progressed and she is in hospice care. She says she’s open to visits: she wants to hear about our summer vacations and wishes to focus on our shared memories and the present, not the future.

Matt texts me and invites John and me to come visit Sunday afternoon. I’m looking forward to the chance to give her the socks, which turned out beautifully—so soft.  I’m ashamed to admit, though, I briefly entertained the notion of not giving them to her—not because she isn’t a dear friend—but because she’ll only be able to use them for a week or so at most.  And they are so beautiful.  And soft.  Thankfully, my better self prevailed in that argument, as I heard my mother’s voice: “You should always give away your best.”

When we arrive, Lola is resting on the living room sofa, dressed in a fitted T-shirt and long comfy lounge pants—cheerful and welcoming as usual. She moves slowly, speaks softly, and keeps pressing her lips together, complaining about how dry they are. I am surprised to see how much more weight she’s lost; under her translucent skin, I can see every tendon and large blood vessel in her neck, shoulders and arms, while her legs and feet are swollen from the pressure in her abdomen. I wonder if the socks will even fit her now.

Lola opens the package as soon as I hand it to her: she holds the socks up to her nose and rubs them against her cheeks. “These will be wonderful,” she whispers.

 

In Any Given Room
Stories on the Indian Experience
by I. D. Kapur
  “Indra Kapur’s writing is illuminating, entertaining, and perceptive, gracing each topic with beauty and wit that leaves you both completely satisfied and wanting more.” Katherine Longshore, author of the Gilt series “Indra Kapur’s courage in embracing and committing her life to another culture is clear. Her stories delight, break our hearts, and show us an India most of us have never seen before.” Ann Saxton Reh, author of the David Markam mysteries. “These stories deftly capture the nuances and contradictions of their well-drawn characters, many from India, in a range of intriguing and dramatic situations.” Jack Adler, author of The Tides of Faith and other novels. Available on Amazon and from you independent book store.

Bios

Nancy Glass is a recently-retired physician who practiced various pediatric specialties for more than forty years, most recently pediatric hospice care. She has been published in Intima: a Journal of Narrative Medicine, JNV: the Journal of Narrative Visions, and Amaranth. She won the 2022 Manuscript Prize sponsored by the Writer's League of Texas for one of her pediatric hospice stories.






Carolyn Schlam is a figurative artist and published author of four books on art. Her work has been shown in many museums, art galleries and publications, and is in the collections of several institutions including The Smithsonian Museum. She resides in southern California.

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