When The Monster Is On The Inside

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Ana, age 13

When my daughter was seven she was prone to nightmares. She was afraid to go to sleep, so I would sit beside her in bed and try to divert her mind from going to the dark places.

“I’m going to see monsters with scary faces,” Ana would say, her blue eyes wide with fear. “I don’t want to go to sleep.”

“Let’s talk about your happy place, okay?” I’d say. “Think of that instead of the monsters. You can go there if you get scared or sad. It’s full of your favorite things, remember? What’s there?”

“Ice cream!” she’d chirp, “and frogs and a big house filled with stuffed animals, and so much candy!”

“How much candy?” I’d ask.

“Mountains of candy,” she’d reply and giggle. “There’s a big lake right next to the house where I can swim and lots of trees.”

“Can the bad dreams get you there?” I’d ask.

“No!”

Then, I’d tuck her in, turn out the light and leave her to dream what I hoped would be good dreams.

But the nightmares always came back.

I started feeling a little desperate. Ana was waking up regularly from her bad dreams and resisting bedtime with increasing frequency. So, I tried something new.

I picked up a dreamcatcher kit from a craft store and assembled it — poorly, but she loved it anyway. I hung it from a little hook above her bed and that night, after we talked about her happy place, I pointed to the dreamcatcher.

“Now, when the bad dreams come, they’ll get caught in the dreamcatcher’s web. They can’t reach you. In the morning, the light will destroy them.”

She’d nodded solemnly. She’d believed.

And you know what? Her bad dreams stopped. I don’t know why. Maybe it was because she had something tangible to protect her from the nightmares. Maybe picturing the bad dreams disintegrating when the first rays of sunlight hit them, robbed them of their power.

The dreamcatcher still hangs above the spot where Ana slept, but the bed is gone and so is Ana.

Ana’s happy place still lives on in my memory. If I try hard enough, I can see it at the periphery of my vision: the house, the trees, the rooms filled with stuffed animals.

But Ana isn’t there. She died two years ago, killed by a monster that grew inside her until she couldn’t breathe. It invaded her body when she was eleven — a tumor the size of a grapefruit that engulfed her liver.

Sometimes I picture it. I can’t help myself. I imagine that it started small, a microscopic cluster of cells hiding within Ana’s body for months or maybe even years, growing slowly, biding its time.

I have photos of Ana in May of 2012, the year she was diagnosed. There was no evidence of the darkness that lurked in the portal vein of her liver. She is bright eyed and healthy in these photos, apple cheeked, happy.

But she’d already started losing weight by then. It was so subtle that I’d assumed she was in the midst of a growth spurt, slimming out and growing tall. Except she wasn’t growing.

The tumor was stealing her nutrients, using her blood to feed itself. She would become thinner, paler, and more irritable throughout that summer. Then her stomach started hurting. The beast had finally come out of hiding.

In his astounding book, “The Emperor of All Maladies: A Biography of Cancer,” Dr. Siddhartha Mukherjee likens cancer to an almost sentient being. Mukherjee writes, “To confront cancer is to encounter a parallel species, one perhaps more adapted to survival than even we are.”

Cancer is the ultimate predator, endlessly patient, lethally precise.

Tumors need an adequate blood supply to grow. They can literally make blood vessels, a process called angiogenesis (angiogenesis occurs in healthy cells too). Ana’s tumor originated in her portal vein which carries blood from the GI tract, gallbladder, pancreas, and spleen to the liver.

A vast majority of the body’s blood flows through the portal vein. It was the perfect feeding ground for Ana’s monster.

By the time Ana had her liver transplant, the tumor weighed roughly ten pounds (she weighted 83 pounds) and, at age 11, she looked six months pregnant. I could see the tumor bulging in her stomach. Its monstrous vessels practically glowed beneath her pale skin.

A brilliant surgeon removed the tumor — along with Ana’s liver — six months after it was discovered. She would need to take anti-rejection medication for the rest of her life, but the doctors said she was cured. They’d beaten the monster.

Ana had MRI’s every three months after her transplant. The first two were clear.

The third MRI revealed two small shadows lurking near her transplanted liver. A follow-up CT scan revealed more spots in her lungs.

The monster was back and it had brought reinforcements.

Ana was twelve when the cancer recurred — long past the age of dreamcatchers — but even if she’d been a younger child, there were no talismans that could protect her from her mutinous body.

We would try, and fail, to defeat Ana’s monster for the next several years, but it never fully went away. Eventually, the nodules in her lungs got larger and more tumors sprouted in her abdomen, pelvis, and bowel. It would be the lung tumors that killed her, starving her blood of precious oxygen, straining her heart until it stopped beating forever. In the end, Ana’s cancer defeated itself — it died because she died.

Sometimes shadows linger long after the horror has passed, replacing good memories with bad, leaving your psyche scarred, forever changed.

I remember what Ana said to me when she was loaded into the ambulance the day they’d discovered the tumor.

“It’ll be okay, mommy.”

Her face, pale as snow, had searched my eyes for reassurance and found only terror.

It wouldn’t be okay. We couldn’t give Ana a happy ending. Cancer would teach her that unlike those long ago nightmares, some monsters win, particularly when they hide inside your own body.

I didn’t believe in monsters before Ana got sick, not really. But then I saw cancer consume her. It took her health, her hope, and ultimately, her life.

Now, the monsters are mine. They are the memories of her suffering, the daily ache of missing her and the terrible guilt that I am alive and she is not. Sorrow, grief, regret and fear — these are the monsters that live inside me.

Occasional poet. Writer of sad essays. Novelist. Birder and amateur photographer. I enjoy trees.

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