At first telling, the story starts Wednesday morning, June 17. I lay under the sheets and watched Mark get out of bed and walk into the bedroom. My husband usually rose before me, and if he didn’t—if I woke with a full bladder—I went to the bathroom and quickly hurried back to bed to lie a few more minutes. Perhaps cuddle. Decide if we’d play tennis or ride bikes. Decide if we’d go out for breakfast.

Mark rarely climbed back in bed. He had a predictable routine: standing at the toilet and then washing his hands and brushing his teeth. He combed his hair, with a few strokes from his forehead back and then with three upward strokes from his neck. I watched every movement. It was a ritual I appreciated from once reading that it is not important if a man spend the night: just if he is there in the morning. Mark and I had woken in the same room almost every morning for forty-two years.

He opened the top right drawer for a pair of white briefs and leaned against the chest while he slipped one leg through, then the other. He pulled out a Steelers T-shirt from the bottom left drawer, and an XL pair of black basketball shorts from the bottom right drawer. He liked to pretend he heard his clothing fighting for the privilege of being his outfit for the day (“Pick me! Pick me!” he’d squeal), but he didn’t that day: he dressed, went to his nightstand, and picked out a pair of white crew socks with gold toes.

Crossing the room, he caught his foot on the chair that jutted out from a small oak desk in our bedroom. Still lying in bed, I watched him fall. The tumble seemed to be a slow-motion scene from a movie or sports replay. He pitched forward, his hands caught the seat of the chair, and he lowered himself to the floor, carefully positioning himself on his back.

I jumped out of bed and immediately saw that he was grinning. I lay on top of him, and we both laughed at his silly clumsiness. When he wanted me to climb off him, he tickled me, and we laughed again.

While I dressed, he went into the kitchen and discovered that Nathan, our twenty-eight-year-old son, had spent the night on our couch in the adjacent room.

“I was too tired to drive home,” Nathan explained, describing a late night at his girlfriend’s house. Mark went outside to pick up the newspaper at the end of the driveway.

When Mark got back to the house, he stumbled up the brick step that led to the front door. Inside, his right shoulder brushed against the family pictures hanging in the hall. In the kitchen, his right arm dragged against the blue countertop.

What’s wrong? I thought.

Mark knew something was wrong too. We talked about what he and I had both noticed, and Nathan jumped up from the couch. Nathan and I were both thinking Uh-oh. Stroke.

“Smile.”

“What’s your name?”

“Put your hands over your head.”

“How many fingers to I have up?”

We considered going to the emergency room, but, like many people in the spring of 2020, were avoiding public places—especially hospitals. We called our doctor’s hotline, but the nurse who answered was perplexed that Mark had no dizziness. She had him confirm that several times before putting put him on hold. Just as the three of us were starting to hum the tune playing and replaying on the speakerphone, Mark hung up. “Let’s just go to the ER.”

Thirty hours later, alone in a hospital filling up with COVID patients, Mark learned he had glioblastoma multiforme. The tumor was in an area of the brain that governed proprioception, the awareness of where his limbs were. Doctors said it was the size of a cherry tomato or walnut.

“In literature and in life we ultimately pursue, not conclusions, but beginnings,” wrote Sam Tanenhaus in Literature Unbound.

People are driven to closure, but when we know the ending, we turn our heads in the opposite direction and seek the beginning. What came before? Biographers interview the fourth-grade teachers of world leaders, and reporters talk to the neighbors of serial killers. Acquaintances ask, “How did you two meet?” and “When did you first realize your daughter was gifted?”

When did Mark’s story of brain cancer really start? Friends asked if I saw anything in hindsight. I recalled one conversation on our daily walk a few weeks before the diagnosis. Mark couldn’t remember the name of a former coworker. Then another. At first, I wondered if I should be concerned, but as he recalled details about the two men and defining anecdotes with kayaks and rental cars, I shrugged off the incident. I predicted that we would have more of these senior moments in the next twenty years, and that was the end of that.

Even after the diagnosis, I didn’t believe that Mark’s mind-went-blank moment on the walk foreshadowed his trip to the hospital. It was a singular incident. Mark didn’t misplace his car keys the way I did. He didn’t roam through rooms looking for his glasses. I wanted something more conclusive than that conversation and couldn’t think of anything that foretold the diagnosis. No headaches, no nausea, no vomiting. No seizures. No previous stumbles.

At night, alone after the sad ending, when the glow of my screen was the only light in the room, I couldn’t let go of the nagging question about the beginning. I typed “when-did-glioblastoma-start” into the search bar. I found the abstract of an article in a medical journal. Noting that patients often asked when their tumor started growing, a team of neurologists and other specialists addressed this question. In their study of 106 patients, glioblastoma age ranged from 156 days to 776 days at diagnosis. I counted backward.

Seven hundred seventy-six days was May 2, 2018.

One hundred fifty-six days was January 13, 2020.

For Mark, the median three hundred thirty days was July 23, 2019.

Mark was an aerospace engineer. When he was overseeing the engine tests for a new launch vehicle, he began recording daily events in marbled composition notebooks and oversized desk calendars. The subject, location, and time of meetings. Milestones met in test schedules. Results of liquid hydrogen test results. Comparisons of NASA and Air Force facilities.

When he retired, he brought the habit home and maintained twelve- by fifteen-inch calendars, with two-square-inch blocks for each day. Every evening he lay on the carpet and wrote down what he had done that day. Kitchen cabinetry and bathroom caulking. Travel reservations. Bills paid. Phone calls made. Lunch with friends. Barber and doctor appointments. Medicine taken. Bike rides, tennis matches, and workouts. He even wrote down the things we argued about: shutters and packages of chicken.

With dates estimating the origin of his cancer, I pored over these calendars.

In May 2018, Mark and I were packing cameras and clothing for a trip to Yellowstone National Park. We planned to drive, stopping at the Grand Tetons on the way, and returning on a less direct route to visit friends in Seattle. In the week of the fourteenth, Mark rode his bike to the beach, went to a yoga class once and a Pilates class twice, and played tennis twice.

There were no red flags. No physical anomalies. Nothing signaled a significant molecular event in one brain cell that could have set off a series of life-ending mutations.

In fact, if Mark’s cancer had started more than two years before it was detected, the slow growth implied would have contradicted what we had been told. The physician assistant who translated medical jargon and test results for us said Mark’s cancer was fast-growing and aggressive. After surgery, his tumor was labeled grade IV: about forty percent of the cancer cells were reproducing and dividing at one time when viewed under a microscope. (In normal cell growth, only one to two percent of cells divide at a given time.) When Mark’s tumor was first detected in the contrast MRI,
the center had already turned black: the tumor was growing so rapidly that its core had already started to die.

January 13, 2020, was a few days after Mark’s sixty-fifth birthday. Mark was attending all the basketball games Nathan coached. He helped our other son, Seth, move furniture from a house in Pasadena to a storage unit. Mark was planning a trip to Spain for the four of us: booking flights, renting a car, reserving hotel rooms, and practicing counting to ten in Catalan.

No signs of cancer had emerged. Nothing.

July 23, 2019, was the median.

Mark was in the middle of a thirteen-day trip with Nathan to see seven Major League Baseball games in four different cities. They had already seen the Cubs play, and the White Sox play, and they were about to see a Nationals game with two of Mark’s cousins from different sides of his family.

Did cancer infiltrate his brain when he and Nathan were threading their way through fans outside crowded baseball stadiums? Of course, there had been no evidence of cancer.

The local librarian got me the complete journal article. It included a mathematical model with terms I had long forgotten. It also included a Gompertzian growth curve describing the complex, almost exponential, early growth pattern of a tumor.

The curve provided a fourth date to consider. The researchers used the growth curve and the size of a patient’s tumor at diagnosis to estimate the number of days the cancer had grown from a radius of five micrometers, which they considered the point of tumor initiation.

I opened the desk drawer with all Mark’s medical files. Discharge instructions. After-visit summaries from doctor appointments, radiation treatments, and chemotherapy. Booklets provided by doctors. My handwritten notes. Prescription receipts and patient information sheets. Drug schedules, physical therapy instructions. A list of caregiver agencies. Hospice checklists. I combed through them until I found what I was looking for: The diameter of Mark’s tumor was 0.75 inch at diagnosis. The Gompertzian growth curve suggested that Mark’s tumor had taken about four hundred days to grow from a diameter of ten micrometers to 19,050 micrometers, or three-quarters of an inch.

The calculated date of origin was May 14, 2019, slightly more than a year before the stumble in the bedroom.

After retiring as an engineer, Mark had made a second career out of fine art painting. In mid-May, Mark sold a quintessential painting of southern California—boats, blue water, and palm trees in the foreground; snow-topped mountains in the background—at a local art show. And, he started planning a four-by-six-foot painting of the football play he believed changed the fate of the Pittsburgh Steelers: The Immaculate Reception.

“The Steelers were losing seven to six with twenty-two seconds left.” Mark told the details to anyone who asked what he was working on at the time. Fourth and ten. Bradshaw. Fuqua. Deflected. Franco Harris. Midfield. Touchdown.

Mark planned to paint the scene from the unique perspective of the end zone, with Franco Harris scoring the first touchdown in Steelers playoff history. Watching a video of the play over and over, he determined what players were on the field and where they were when Harris crossed the line. He researched their height and weight. He determined who the officials were and where they were positioned on the field. He studied coaches, players, and others on the sideline.

He posed an artists’ mannequin in various football stances and began pencil drawings.

Immersed in his project, he showed no symptoms of physical or mental changes.

We pursue beginnings to satisfy curiosity, determine cause, or seek control—or the illusion of control. Friends wanted the assurance that no one in their family was on the cusp of suffering the same thing. I quietly wondered, barely daring to voice the thought, Did I miss something? What could I have done differently? I searched, and researched.

I continued to pore over the memories recorded in journals and calendars and match them to the glioblastoma inception times. I studied photographs—posed vacation and holiday shots, self-timed smiles, unposed snapshots—taken before Mark fell in the bedroom. When he sported his COVID mask, before he was fitted for a radiation mask. When he painted at his easel, before he was no longer able to write his name. When he sat on the curb with a croissant in one hand and a cup of coffee in the other, before he sobbed some days and raged others.

More than four dozen photos sat on a bookshelf, displayed for a memorial open house and never put away. I stared at them every day. Walking out of his red-bricked dorm the year we met. Holding my hand as we walked onto the dance floor at our wedding. Hugging our two sons to his sides, year after year. Hiking. And my favorite: hanging over the side of a boat, arms spread wide in boundless joie de vivre. I knew I wouldn’t see any signs of the malignancy in these memories, but I realized what I was looking for. I picked up the photos, brought them closer to my eyes so his smile was bigger, and assured myself that he had enjoyed his life and knew the love of his family.

That was the answer to what came before.

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