In the chemotherapy waiting room

We register, and then we walk a few feet past the registration area into the waiting room. It’s a large area, perhaps 30 feet wide and 70 or 80 feet long, with couches and chairs arranged to provide lots of little areas which you can feel you’ve made somewhat your own for the duration of your wait.

When we arrive, early in the morning, the room is quite empty. By later in the day, it gets pretty full, and that makes sense, because there are about 20 separate chemotherapy cubicles, and the actual process of receiving a chemotherapy infusion takes (at least in my case) about 3 hours. So in a day that begins around 7 AM and ends around 6 PM, it’s probably possible for 3 patients to get infusions in each of those 20 cubicles: perhaps 90 people every working day, just on this one floor of Sloan-Kettering.

There’s another difference between early morning and mid-afternoon, or at least it seemed that way to me one afternoon when we spent a long day there: by mid-afternoon there are more people waiting who are obviously very, very sick. Cancer, I’ve been realizing, is quite unlike the usual diseases of daily life: when you get the flu, you lie down until you’re better; but when you get cancer, if you’re fortunate, you don’t lie down. You continue with as much of your normal routine as possible, even though you are actually much sicker than if you had the flu. But of course cancer can ravage its victims, and my impression was that more of the people who have really been through a wringer are in the waiting room later in the day. That too would make sense: it probably takes these patients, and their caregivers, longer to handle all the logistics of getting to their appointments, and their appointments are set up with those logistics in mind.

But while 90 patients are having chemotherapy every day, the waiting room is large enough to hold something like that number of people at any time. The reason the room is so large is that few people go to chemotherapy alone. Cancer treatment, it turns out, is a social process. There are exceptions, certainly, people who come alone and people who come planning to work, and the waiting room offers a few desks at which people can work if they’re so minded. But most people seem to arrive with family members (and some, I know, with friends).

There are medical reasons for this, certainly. Actually getting chemotherapy is (at least in my experience so far) uneventful, but it’s a long day and it’s a great help if someone else is there to help you get home. There may be important conversations to be had with the medical team, moreover, and a spouse may be able to report on symptoms, or aspects of symptoms, that the patient would miss. Sadly, that must be increasingly true the more weakened the patient becomes.

But I don’t think the medical reasons are the full explanation. It seems to me that most people with cancer naturally want the company of their family or friends. The disease is so formidable that it is good to be with the people you love and trust.

At the same time, my impression is that the groups that form – the patient and his or her companions – are rather subdued. Again, there are exceptions. On our first day at MSK, for instance, we sat near a man who was engaged in nonstop cellphone conversations. In a later visit, we watched as two patient/family groups began talking with each other – though it seemed to us that the patients in each group were the quietest, while their companions were chatting vigorously. But by and large it seems to me that each little group sustains itself, whether by talking or simply being together, but quietly.

The room itself lends itself to this. The main decoration in the area is a metal sculpture or screen dividing the registration area from the waiting area. The design of the screen is of a tree, and the screen also includes words (from Ezra Pound, my sister Maud tells me): "I stood still and was a tree / within the wood / knowing the truth of things unseen before". Those suggest reflection, quiet, even solemnity. And the room as a whole does too: patients are not in despair, and they are not alone, but they and those with them face something very profound.

PS: But there are some exceptions! Yesterday the waiting room was full most of the time we were there, and some people were talking vigorously -- and in the chemotherapy cubicles on either side of us folks had a lot to say, including one patient who was working his cellphone at length. Fortunately I slept through most of this.