XOXO

As John waited for the doctor, he studied Mandy’s Tinder profile, preparing for their date that afternoon. She was definitely his type, with sandy blond hair and grey-blue eyes. She, like most women on Tinder, enjoyed “yoga, wine and walks on the beach.” Through their text messages, he learned that she was an administrative assistant pursuing a nursing degree. Would she be the type who would pretend to be cool and then suddenly explode as he slowly lost interest, or would she be the sensitive, clingy type who wanted commitment after meeting for coffee? There was a softness in her heart-shaped face and an eagerness in her eyes that made him think she was the second type. In the end, he treated all the inevitable breakups the same, repeating the same words. “Please don’t take it personally. You deserve someone better.” It’s right there in my profile: Not looking for anything serious, he wanted to shout sometimes. It amazed him how women just chose to ignore this, either overestimating their ability to make him commit or underestimating what they were looking for. But he was only thirty-two, six feet tall with olive skin and a full head of dark curls, and he had a decent paying job as an accountant at a boutique accounting firm in Boston. As far as he was concerned, as long as he had options, he wasn’t going to commit.

The opening door drew John’s attention from his phone. “Hi, I’m Dr. Ruggiero. Nice to meet you, John.”

“Hi, Doctor,” he said, shaking her hand. Not bad for an older woman, he thought, working his way up from her slender ankles to her chestnut hair as she led him to the exam room. She had the healthy glow of a forty-something actress from a probiotic yogurt commercial.

“So, you’ve been having some bad headaches?”

“Yeah, for a few weeks now. I thought I was going to pass out from the pain this morning. The Advil isn’t cutting it anymore. Maybe I need a prescription.”

“Any history of migraines?”

“No, never.”

“How’s your appetite been?”

“Not great, things have tasted a little off lately,” he said, recalling that his oatmeal that morning had a metallic aftertaste that still clung to his mouth.

“How’s your energy?”

“Well, the migraines do kind of knock me out.” He tried to recall the last time he had ridden his bike—had it really been two weeks ago? His bike, which he rode almost daily and usually felt like a part of his body, had fought him with every pedal stroke on that last ride, though it was the same path to his office in the Back Bay that he rode every weekday.

“I think you should have a CAT scan as soon as possible. Do you have time this afternoon?”

“Can we do it tomorrow? I have plans later. I’m feeling fine now.”

She smiled sympathetically. “I’m sorry, you really don’t want to put this off.”

John sighed. “If you insist.”

“I’ll call tomorrow with the results.”

As John waited for his CAT scan, he took out his phone to message Mandy.

The stew of odors created by the cafeteria food, industrial cleaning supplies, and bodily fluids churned John’s stomach. What was he even doing here? He was young and healthy, unlike all the elderly patients that surrounded him in the CAT scan waiting area. It seemed so silly now, going to the ER for some headaches. He debated walking out, but just as he rose to leave, a radiologist called his name.

The following afternoon John was seated in an oncologist office. The whole morning had been a blur. The call from Dr. Ruggiero saying the CAT scan was abnormal and insisting that he come in for an MRI that day. The call to work to let them know that he would be out again. Waiting to get the MRI done. The phone call to his sister Beth, who drove from Plymouth to MGH immediately after he told her that he had a consult with a neurological oncologist that afternoon. The mother of three children, Beth could be relied on in a crisis.

“Let’s not tell Mom,” he said, as they waited for the oncologist. “Not until we know more.”

“Alright, that’s your decision. It’s going to be fine though, I know it. It’s just a mass.”

“It’s a tumor, Beth. Cancer. That’s why we’re meeting an oncologist. Shit, what time is it?” He grabbed his phone and saw it was already 4:00 p.m., and there was a message from Mandy.

Before Mandy replied, the oncologist entered the room. The sunny glow of Dr. Ruggiero had been replaced by the weary competence of Dr. Tsoulas, referred to as “best glioma guy in the city.” The doctor’s monotone voice did nothing to make John optimistic. “Stage IV...surgery in two days...radiation five days a week...three to four rounds of chemo…” John seemed only to hear the numbers Dr. Tsoulas was saying, the rest of the words beyond his understanding. He nodded his head and felt his sister’s hand on his arm. She insisted on a cup of coffee in the cafeteria before returning to Plymouth to collect some belongings before returning to his apartment, where she would stay until the surgery.

“I’ll be at your place around 7:00, depending on traffic. Should I call Mom?”

“Yeah, I guess it’s time.”

“Anything else I can do?”

“No, just...thanks.”

“That’s what older sisters are for.” As Beth headed out, John checked his phone and saw Mandy’s reply.

One word. But a damning word, ringing with indifference. I haven’t even met you yet and you’re already breaking out with the “Whatever”? Fuck, I have a brain tumor, bitch. Give me a break. He rolled his eyes, stuffing his phone into his pocket. It wasn’t worth playing the cancer card with some girl he had never met. He braced himself for the train ride home and the inevitable, hysterical phone call from his mother.

Within a week, John was home recovering from the surgery that had removed the cancerous glioma from his brain. Surgeons had cut his skull, removed his brain, and sliced away at the cancerous cells. It amazed him that he was walking and talking, as if he had just had a mole removed. Yes, there was fatigue, but that was to be expected after a major surgery. His doctors told him the surgery had gone well; they had removed a substantial part of the tumor, and chemo and radiation should shrink what they couldn’t remove. They said he was young and healthy, the ideal patient to survive this type of cancer. The left side of his head was shaved, but if he looked at himself from a certain angle the scar wasn’t visible.

His mother arrived from Connecticut and commandeered his guest room, trying to fight the cancer with a whirlwind of activity that included cleaning his apartment, cooking his meals, and driving him to his medical appointments. His life developed a completely different rhythm. No more going to the office, no more bike rides, no more dinners with friends or Tinder dates. His time recovering from the surgery was spent sleeping odd hours, watching television, and fighting the urge to research his prognosis. Then there were the medications. So many medications: Diazepam to prevent seizures; Amoxil to prevent infection; and Heparin to prevent blood clotting. And the conversations. So many personal conversations with cousins, neighbors, and coworkers with whom he had only made small talk before. It had become a script by the time he spoke with his aunt in California. Great to hear from you! I know- crazy, right? Feeling good. Doctors are optimistic. Chemo and radiation start next week. Yeah, Mom and Beth are lifesavers. On medical leave but hope to go back soon. I’ll keep you updated. Thanks for checking in!

His mother encouraged him to walk around the neighborhood, insisting that it would help his recovery from the surgery. As they walked together, he pictured blood flowing from his heart to his toes and fingers and brain. Not as good as riding the bike, but he wasn’t ready for that yet. One afternoon, they walked behind a woman with a blond ponytail, wearing loose, cuffed jeans and a gray tank top. That can’t be, he thought. But something about the shape of her face and that particular shade of blonde made him certain that it was. Average height, curvy build...just as she said in her profile. Mandy lived in Somerville, but it was entirely possible that she was meeting friends for Sunday brunch in South Boston. The woman stopped at the corner, reading her phone as she waited for the walk signal. He smelled her perfume, a vanilla jasmine musk, and saw freckles on her shoulders. His mother approached the corner, stepping to the right of the girl. Blood rushed to his face and his stitches itched under the bandage. He stepped back and walked to his mother’s right side.

“Everything okay, hon?” his mother asked, when he hesitated before crossing the street behind Maybe-Mandy. He stared at her derriere, perky and taut. It was one angle he had not seen in her profile.

“Yeah, I’m fine,” he said, turning left. “Let’s turn here—there’s a Starbucks this way. I haven’t had coffee in ages.”

While the recovery from the surgery had been smooth, the side effects of the chemo and radiation which began two weeks later blind sighted John. He had no appetite for his mother’s cooking, no energy to walk around the neighborhood, and the apartment suddenly seemed cramped. The panicked look on his mother’s face and his sister’s constant questioning about how he was feeling irritated him. He became nocturnal to minimize his interactions with them. He lived with his face burrowed into his iPad, staying up late into the early morning watching videos, reading news blogs, and scrolling Instagram.

One night, after reading every possible news website and social media update several times, John was still far from sleep. There was a notification from Tinder, reminding him that he hadn’t logged on in weeks. He logged on to deactivate his account and saw the last one-word message from Mandy: Whatever. She was going to work, taking exams, having brunch and going on Tinder dates. And he was stuck in limbo, the lifestyle known as “cancer,” just treading water against the inevitable. Feeling reckless, he located her Instagram page. So oblivious, so healthy, bouncing around South Boston with her blond ponytail and perfect butt. There she was at the Celtics game the weekend before, her arms wrapped around a brunette with the same hairstyle. Am I really Insta-stalking this girl? A pumpkin-spice-latte drinking, North Face-wearing basic bitch? Surely a personality change brought on by the brain tumor, he thought. It didn’t seem fair that she should sail through life unscathed, while he was stuck and suffocated.

Just send her a message, he thought. But he couldn’t message her as himself. She would eventually want to meet, if she hadn’t already written him off as flaky. At some point, he would have to reveal the cancer, and he was tired of talking about it. He could, however, message her as someone else. A guy without a malignant glioma and chronic nausea. A guy without a scar in the side of his head who didn’t wince at the hair that fell in the shower each morning. He created a profile for “J.T.” on Instagram. He couldn’t use pictures of himself, since she knew him from his Tinder profile. He logged onto Facebook and found pictures of his cousin, who had the same skin tone, eye color, and hair color, hanging out in Chicago with friends. Examining the result, he decided that she probably wouldn’t associate the man in this picture with him. He was ready to message her:

John woke the next morning and checked his phone, disappointed that Mandy hadn’t replied yet. Maybe she saw through the fake profile, or maybe she was dating someone else now. Later that afternoon, driving back from his radiation appointment, as his mother rambled on about new research on ketogenic diets and cancer, he saw Mandy’s reply on Instagram:

Smiling, he wrote back:

And just like that, she was telling him things about herself that he already knew: she was a secretary taking classes for her nursing degree who lived in Somerville. Knowing that the easiest lies to keep straight were those which were closest to the truth, he said he was a senior level auditor at a large firm who traveled for work regularly. He figured that would enable him to delay meeting her, at least for a while.

“There’s a smile I haven’t seen in a while,” his mother said, looking over from the driver’s seat, trying to see what he was reading on his phone.

John and Mandy wrote to each daily, at the very least wishing each other good morning and good night. Mandy talked about her family (“Typical large Italian family, whether we’re happy or angry, it all sounds the same- LOUD”), outings with her friends (“I hate Whiskey Priest, but she would have been pissed if I didn’t show up”), and her job (“I can’t wait to leave this hellhole. This degree is taking FOREVER.”). John talked about visits from his niece and nephew (“Love seeing the kids- but glad when they go home!”), trips for work (“They’re sending me to Portland AGAIN”), and places in Chicago (“Strolled through the Art Institute after work- amazing exhibit on 1930s paintings!”). Communicating with Mandy, with all the research and imagination it entailed, filled the void that had been created by the vacuum of cancer. The chemo symptoms eased, and he wasn’t sure if it was the distraction Mandy provided or if it was because the intensive period of the chemo cycle had ended. Eventually, after two or three weeks, the message he anticipated arrived from Mandy: Hey, want to facechat sometime?

John considered all the possibilities. He couldn’t tell her the truth, and he could only put her off for so long. He was feeling well, and with the right adjustments, he could pass for the cousin whose photos were on his profile. He wrote back: Sure, at the gym right now. Maybe tomorrow night?

The following night, John donned a baseball cap and dimmed the light in his bedroom. Feeling like a guilty teenager, he locked the bedroom door to prevent his mother interrupting. His heart raced as he entered Mandy’s phone number and he waited for her to pick up.

“Hey J.T.!” she answered with a wide smile. Her voice was deeper and more sensual than he expected. With her hair down, in a black T-shirt, she looked so natural, so warm, he could practically feel her body heat through the screen. Even with the knot in his stomach, fearing that he was seconds away from being exposed, he couldn’t help but return her smile.

“Hey Mandy! Nice to finally hear your voice. What’s going on? How was work?”

“God, today sucked. I asked Jeff for a modified schedule so I can do my nursing clinical next semester and he’s being a total jerk.”

“Well, stand your ground. You have to finish your requirements. You’re not meant to spend your days pushing paper. Your heart is too big.”

“You’re too sweet. Did you watch the game last night?”

“Of course I did. Irving was fucking amazing…”

And on and on the conversation went, and John felt as if they were sitting across from each other, talking easily and familiarly. It was two hours before Mandy said she had to get to bed for an early morning. “I would say this was a successful first date,” she said shyly with a smile.

“Absolutely.”

“You know, my friends were a little unsure when I told them about you. I mean, you have to be weary of guys who DM you on Instagram. But it seems like you’re genuine.”

“It’s not every day I DM a girl on Instagram. But you seemed special. I mean, you are special.”

“Have a good night!”

“Sweet dreams!” He ended the call, thinking it was the best “first date” he had ever had. Her voice, her smile, her confidence all drew him in, making him want more. Had he ever felt that feeling before? He briefly wondered where this would all lead before dismissing the thought and shutting off his light.

The following morning John’s mother shook him awake. “Time to get up, John. We have to beat the traffic.”

“Traffic? Where are we going?”

“MGH. You have an MRI today.”

“Right, right. I’m up.”

A half hour later he was seated next to his mother on his way to the hospital. He sent a quick text to Mandy: Morning beautiful. Enjoyed talking with you last night. XOXO. He debated erasing the XOXO, wondering if it was too much, but pressed send before he thought about it too much.

“How are you feeling today?”

“Mom, could you stop asking that? If I’m not feeling okay, I will let you know.”

“Okay. I just want you to know how proud I am of you. You’ve been so strong.”

“I don’t really have a choice, do I?”

“I know it’s been hard, but before you know it you’ll be back to work and back on your bike.”

“I hope so.”

His phone beeped with a message from Mandy: Good morning hon! Hope we get to facechat again soon! Have an excellent day! XOXO.

After the MRI was done, he and his mother headed to the cafeteria to wait to meet with Dr. Tsoulas. As they approached the chapel, his mother tugged at his arm. “Let’s step in here,” she said.

“Damn, you must be worried about me if you’ve started praying.”

“I’ve been praying since Beth told me. And I can’t explain why but it helps.”

John slid in the pew next to his mother, who kneeled and bent forward with clasped hands. He hated that she was so worried about him, hated that the only topic of conversation between them was cancer. He wished he could talk about a difficult client he had to deal with that morning, or the number of miles he had biked that evening, or even Mandy. She would love to hear that he was serious about a girl. But how much could he tell? At the very least, it was too soon. Maybe one day. He bowed his head down and said a prayer of his own.

John could feel his mother’s heartbeat as he sat next to her in Dr. Tsoulas’ office. “Good morning,” said the doctor entering. John and his mother tried to keep a straight face, recalling their impressions of Dr. Tsoulas’ monotone demeanor. “Well, the residue of the tumor left after the surgery has shrunk approximately sixty-five percent. There’s still an area of concern, but that’s as good as we can expect.”

“Thank god!” his mother exclaimed.

“We’ll continue with the treatment as scheduled and keep monitoring you. But everything is going well.”

John grinned at the first good news since that phone call from Dr. Ruggiero. Was it okay to be more than “cautiously optimistic” now? Maybe they were right. If anyone could beat this, it was someone young and healthy like himself.

“My prayers are working,” his mother said, hugging him tightly with tears in her eyes.

John’s mother returned to Connecticut after he finished his second round of chemo, and he made arrangements to work from home on a part-time basis. He and Mandy continued to share the details of their days (hers true, his manufactured). He debated telling her the truth, since he was feeling better, but he feared telling her the truth could mean an end to the messages and video chats that he so looked forward to. During one conversation, she casually mentioned that she was making plans for her birthday. When she told him what day it was, he said that he was sorry he couldn’t go to Boston and spend it with her since he would be traveling to Portland again.

“What would a girl expect from a guy on her birthday when it’s still early and you’re getting to know each other?” he asked his sister, who had stopped by for a visit with her children.

“Dinner at her favorite restaurant. Red roses—from the florist, not the grocery store. Maybe a nice necklace?”

“No, not for this girl. That’s not personal enough.”

“Can it be? You’ve actually met a girl who makes you nervous? Where did you meet her?”

“It’s someone I knew from before. I don’t want to get into it.”

“Look at you, fighting cancer and still a chick magnet. I have to admit, I’m kinda impressed! When do I get to meet her?”

“I knew I shouldn’t have said anything.”

“I don’t know. I have a feeling about this one. You liiiiiiiiiike her,” she said in a sing-song voice.

“What are you, twelve?” he asked, blushing.

Several days later he received a text from Mandy:

John woke early the next morning. It was already sixty degrees and the sun was beginning to burn the early morning clouds. B.C. (Before Cancer), he would have considered this perfect bike riding weather. But he hadn’t ridden since his diagnosis. He looked at his bike, decided that he had fully recovered from the last round of chemo, and took it outside. He pedaled down the street slowly, becoming reacquainted with the feel of the seat and handles. He circled around the block, feeling the familiar acceleration of his heart rate. Still fine, he thought, and decided to head towards Castle Island. Exhilarated by how well he felt, he headed towards Newton down Huntington Avenue. He didn’t want to rely on the results of an MRI; he wanted to test himself and bike up Heartbreak Hill. As he ascended the hill, he began to feel the lactic acid building in his thighs. All the trees to his sides disappeared, blurring into a tunnel of golden light. With every pedal stroke, he cut the head off another astrocyte cell in his brain. He was going to beat this thing after all. And everything was possible. He could be John with Mandy, merging the two worlds with a simple conversation. She would be mad at first but surely she would forgive him. How can you stay mad at a cancer survivor? And it would make a great story to tell their children.

Two weeks later a sharp back pain kept John in bed for a day. He tried ice packs, exercises, and pain killers, thinking it was a muscular issue. When he woke up the next morning, still in pain, he called Beth. “Can you come take me to the hospital? I can barely move.” He looked at the calendar. Eight months since his diagnosis.

After two days in the hospital, where he used a wheelchair to get around, he finally had a consultation with Dr. Tsoulas. “Metastatic drip...cancer on the spine...surgical options...physical therapy...pain management.” After it was determined that some alternatives would be tried prior to surgery, and that he would return home, a nurse went over the discharge instructions with him and his mother. “Now your case manager has ordered a wheelchair for you, so you can take it with you to use at home.”

The possibility that he wouldn’t be able to use his legs at home hadn’t occurred to John. Conscious of his mother and Beth’s eyes on him, he just nodded.

John’s mother returned to his apartment, and he felt chronic exasperation at the pity in her eyes as he rolled around the apartment in the wheelchair. His days were now spent going to doctor’s appointments to determine whether surgery was an option and attending physical therapy. After a few weeks, John’s legs atrophied from lack of use. All the muscle tone that he had built bike riding seemed to migrate to his arms, which had grown from steering the wheelchair. On one of his better days, he took a photo of his flexed bicep and sent it with a message to Mandy: I’ve been working out for you. 💪😄 His messages to Mandy now consisted mainly of deflecting any attempts to schedule a visit and avoiding facetime chats. He sensed that her patience with him was growing thin, as he continually rejected her offers to visit Chicago. He debated writing a text telling the truth: I’m sorry, I can’t meet you now, or ever. I have tumors on my spine. 😷😥😵 But the truth was so absurd she probably wouldn’t believe it.

“So what’s going on with that girl you mentioned a while back?” Beth asked, when he was readmitted to the hospital.

“Does it matter? In case you haven’t noticed, I’m dying.”

“You’re not dying.”

“I don’t want to live anymore.”

“This is just a setback. You’ll get through this.”

“Didn’t you hear what the doctor said? I’ll never walk again. And I’m hopped up on painkillers and antidepressants just to get through the day, which I spend lying on a hospital bed.”

“But I want you to live,” she said, her voice breaking. “And what about Mom?”

“The cancer doesn’t really care what anyone wants.” Fucking pity. That was all he saw in Beth’s eyes. And it made him angrier. “I’m not living my life in a wheelchair from one surgery to the next. And that’s my decision to make. I want to be discharged to hospice.”

“You can’t mean that.”

“Can you leave? I need rest.”

“I’ll be back tomorrow.”

“Whatever.” He felt a chill as she left the room. Some hospital pamphlet had probably prepared them for his behavior, which it would describe as a “coping mechanism”: alienating loved ones to prepare them for his passing. He picked up his phone and noted that Mandy hadn’t texted that day. He couldn’t blame her. He didn’t have the energy these days to create lies or engage in flirty texting, and she was probably growing bored. Maybe he should just let nature take its course; the thought of literally “ghosting” her amused him. But he had another idea.

There was something strangely satisfying about his ability to hurt her. Certainly this was fairer than completely disappearing. She would be fine. She would meet other guys on Tinder, and she would never know the truth.

John felt drowsy and lightheaded, side effects of the morphine flowing into his veins through an I.V. He felt suspended in air, as if he were standing still on a tightrope. He knew he would either summon the courage to continue forward or fall off to one side after his tense, exhausted muscles gave way. He hadn’t eaten in a few days, but he felt no hunger. He heard the voices of his mother and sister, and it comforted him. They greeted a third female voice that was hard to place, and he smelled vanilla jasmine musk. After several minutes of quiet conversation between the women, John felt a timid, warm hand touch his own. This was not the competent, cool touch of his nurses, nor was it the desperate grip of his mother and sister. He saw sandy blond hair framing a heart-shaped face and blue-grey eyes. “Hello, John,” she said.