Working Through Images, Part 2

The Language of Cells: A Doctor and His Patients
by Spencer Nadler, M.D.

(Page 2 of 2)

I retrieve all her breast and lymph-node slides from the file and move her chair opposite mine. With effort, pain maybe, she leans across the desk to peer through the alternate set of eyepieces on my two-headed microscope. Resting her elbows on the desktop, she looks in on the events of her body-cells long dead, now fixed and colored-that have given rise to her illness.

She listens quietly as I move the pointer across the microscopic landscape. "These clustered islands of glands are the lobules," I tell her. "Milk is produced here in the lactating breast."

"They look more like pink hydrangeas to me," she says, "a sprawling garden of them." She talks excitedly, asserting interpretive authority over her own cells. I can only imagine the variety of forms a cellular array such as this might suggest to an uninitiated eye.

"And these?" she asks. "What are they?"

"Ducts," I say. "They transport lobular milk outward to the nipple."

"My God. Look at them," she says. "Ponds, lakes, rivers, estuaries that carry milk. It all looks so peaceful." With her legs braced in the chair, she hoists her torso onto my desk and hunches over the microscope to get a better view.

There is little need for pedagogy; she is finding her own truths with metaphor. I switch from the four-power objective, the scanner (a magnification of forty), to the forty-power objective (a magnification of four hundred), and individual cells take prominence over cell patterns.

She clasps her hands together. "It's as if all the planets in the universe have come together here."

"See the uniform cells lining the lobules and ducts?" I point out the blue nuclei, the pink cytoplasm, the discrete nuclear membranes.

I switch back to the scanner and we pass over fields of ducts and lobules. I suspect it is a whimsical leitmotif she sees, hydrangeas, ponds, rivers suspended idly in fat and fiber, floating serenely.

I wait a few minutes, allowing her to absorb the beauty of her own cells. Sitting perfectly still, crooked like a pliant ballerina, she inspects her cellular self.

Reluctantly, I replace the slide of her normal breast tissue with one of the cancer.

"Whoa," Hanna says.

She stares into the microscope, transfixed by the disarray of her malignant growth, a raw view of her life spread out before her. "These cells look like distorted hula hoops," she says. "It's all damaged, isn't it? Just like my real world."

"This is your real world, too," I say.

She looks at me over the top of the microscope. "People don't shun me because my tumor ducts look like reckless hula hoops."

Like Charon ferrying between the living and the dead, she glides back and forth between her threatened life and her dead, stained biopsy cells. She quickly grasps the cause and effect-critical cell changes are twisting her life. For years I have processed thousands of such cases, determined the manifold forms of disease, but I've never been an intimate part of anyone's illness, never felt the connection of cells to a larger self.

"Losing my hair terrifies me," she says. She fingers it, pulls at it gently. Not a single strand comes out, and she is reassured. "I've got a wig, but I hate it. So I wear baseball caps and tie scarves through my hair. I'm lucky. I look good in scarves. Still, I feel hideous. People think it's just vanity. It's much more than that," she says. "Every time I see my scalp poking through, I'm reminded. I feel how different I am. How lonely."

"You'll have your hair back in a few months," I say.

Tears well in her eyes. "That'll help a whole hell of a lot."

In The Notebooks of Malte Laurids Brigge, Rilke writes, "If I am changing, then ... I am no longer the person I was, and if I'm something else, then ... I have no acquaintances." I believe that Hanna's perception of her disease-tainted self is one source of her loneliness; she will have to be her first new acquaintance before others can come along. And it pains me that all I can offer her is my familiarity with her cancer cells.

"What chemotherapy does to me is unbelievable," she continues. "After a treatment I wake up around midnight with a funny taste in my mouth, and then boom, an incredible indigestion-like a volcano-with nausea and vomiting that rips my insides out. It's excruciating. Every bone in my body aches. Things stop for a while, then it starts all over again. Off and on for the rest of the night."

She is on Cytoxan and Adriamycin, she tells me. These drugs act during mitosis to prevent cell reproduction, destroying the rapidly growing cancer cells, hair cells, bone marrow cells, and cells lining the gastrointestinal tract. Hence the tumor destruction, hair loss, reduction of blood cells, nausea, and vomiting. It's a savage exposure, a supervised chemical warfare.

"I was alone in bed one night last week," she says, looking up from the microscope. "My husband was out of town, my kids were asleep, it was after midnight. I lay there staring at the ceiling, scared out of my wits, shaking uncontrollably. Suddenly a warm white light beamed through the window and rested on my chest. It was a miracle, the way it soothed me to sleep." She slides back into her seat. "I realized when I woke up that God was looking out for me."

I am moved by the way Hanna aligns herself with all her positive expectations.

six years go by before Hanna Baylan reenters my life. I have not asked after her, nor have I received word of her struggle. I have retained the professional cool, the isolation that has been so much a part of my life.

Once again Hanna appears at the end of a long day. She walks slowly and sits down with some difficulty in the chair by my desk. She's frailer now, and her pallor makes her eyes seem dark, watchful. Her cancer, she tells me, recurred the year before. Three spots in her ribs, one in a lung. She submitted to high doses of chemotherapy, more toxic than before, then underwent a bone-marrow transplant.

"The cancer in my bones was like a little old lady," she says. "It puttered around, came and went. But I could deal with it." Her jaws tighten. "It's the drugs, not the cancer, that are so hard to take. People who haven't had chemo never really understand that. And it's the fear that you may die. It's been hard to come to terms with that."

She outlasted the poisons, metabolized them. The cancer in her bones and lung disappeared from view. Cells harvested from her marrow before this chemotherapy were then returned to replace what the drugs had destroyed, hopefully to spawn a new remission.

If she is to succumb to her illness, her bearing shows no hint of defeat.

"I'm here to see my cancer cells again," she says. "I'd like to see them projected on the big screen, like you did at your lecture." Her arched brows reflect her resolve. "I need to confront them one at a time to get a handle on them."

I set up the xenon projector in the hospital auditorium. Before long we are alone in a large, quiet space.

I project one of her biopsy slides onto the screen, magnifying her cancer cells to the size of golf balls. They glare at us like cyclopean monsters-granular pink bodies clinging to one another, each nuclear blue eye reflecting its own confusion.

Copyright © 2001 by Spencer Nadler. Excerpted by permission of Vintage, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

About the Author

Spencer Nadler, M.D., has practiced surgical pathology for more than twenty-five years in Southern California. His essays have appeared in Harper's, The Massachusetts Review, Cross Currents, The Missouri Review, The American Scholar, and Reader's Digest. The Language of Cells is his first book.