The guilty pleasure of Christmas cookies

Each year, as Christmas draws near, she calls in for a visit. I have almost forgotten how long it has been, for to count the years might be to jinx our luck. But each December, as she sits in the waiting room, the other patients eye her, wondering what she carries that needs a seat of its own. After all, some of them also bring in gifts at that time of the year — a small box of chocolates or a discreet bottle of wine or simply a card that says thank you for being my oncologist. Like fingers on a hand, they are all precious. To think that a patient who hasn’t slept all week in anticipation of a result could still find time to think of someone else is to be humbled. But I’d be lying if I didn’t say just how much I look forward to this particular patient and her particular Christmas gift.

The first year, they came in a small box and I ate them in one fell swoop. I sang their praise so much that the next year there was a larger box. This time, I put them under my desk, promising that such treats demanded to be shared with my children. But it was a long afternoon and I poked a little hole on the side, which grew larger and larger as I nibbled and nibbled, until feeling a little aghast at my temptation-fuelled appetite, I saved the rest for home. The children swept upon the gift with glee, as I reported the next time I saw her. She was so tickled that in the years that followed, the box turned into a wide tray, its contents ever fancier. It was her way of saying let’s continue this bargain — you keep me alive and I bake you the kind of Christmas biscuits that you simply can’t find in a shop.

She is right about the biscuits. At 70, she tells me that she uses a recipe dreamt up by her mother and her mother before that. The ingredients can be found in any shop, but the final product is priceless. That’s why the edges crumble just so, and under layer after layer of the most delicate tissue, the decorations twinkle and gleam just so. The delight on my face at this gustatory tableau says it all. After all, why should I hide my naked appreciation of how happy she makes me and my whole family? I love this annual indulgence and she loves to indulge me.

But ultimately, the festivities must be put aside as we turn to discuss the cancer that she has had for an incredible 15 years. Her incurable, metastatic disease continues to respond to active treatment, the word “indolent” etched in her mind, although from time to time she asks, “What’s that ‘i’ word again? Tell me again what it means”.

I explain to her what “indolent” means, pausing ever so slightly at the caveat that always accompanies it: cancer cells can change their behaviour unexpectedly and there is no test to predict when. In the meantime, I manage her off-and-on pain, treat common infections and meticulously attend to her minor problems so she feels cared for.

“I hope you will stay well for a very long time,” I say.

“Got to keep baking,” she hints, and we laugh together.

Her husband proudly reports that the Christmas biscuits are a week-long production involving the matriarch, the adult children and all the grandchildren. Everyone has a job in this ultimate family-building exercise. And then, the goods go out to spread happiness and cheer in far-flung places. When she is in my clinic at regular intervals and I take in her various expressions — anxious, resigned, angst-barely-controlled — I try to picture her in her kitchen, where she has power, control and agency. What does she think of while baking her Christmas biscuits each year? Does she fret that it might be her last or does she pick up another almond or a glacé cherry and banish the very thought? Mostly, she strikes me as resilient but there are times when tears prick her eyes because she is tired of the routine. She is tired of people saying “but you look so well”; tired of my appointments being the signposts of her life; tired of my saying that the miracle cure she saw on television is neither miracle nor cure. As her oncologist, I think she is my best patient, but I guess there is no such thing as being grateful for having cancer.

As Christmas approaches, I find myself growing anxious. I lightly joke about the sugar hit I should stop inflicting on my older self but in reality, I dread the day she is too unwell to make the biscuits. Because what will that mean? It will mean her liver metastases finally made good on their promise to cause havoc. It will mean that the lung nodules I said were too tiny to give her trouble decided to prove me wrong. It will mean that the bones that ached but faithfully carried her weight finally rebelled. It will mean the end of an era for us all.

I want to prepare us both for that day but in our cocoon of present safety surrounded by a sea of uncertainty, I wonder how. So, without a protocol to guide me, I do what feels right. Each time I see her, I tell her how much I admire her resilience and her sheer ability to work through fear and pain to continue doing the things she enjoys, like dancing, cooking and entertaining. What seems second nature to her is the undoing of many patients well before it is even necessary. I tell her husband how much I admire his unwavering support for her. In all these years, he has not missed a single appointment. He is a wise and quiet presence, speaking only when needed but always ready with a calming word and a soothing gesture. I can’t fathom how deep a well of love must be needed to do his job but I know not everyone can do it for so long. And finally, I tell her that neither of us can dictate the whims of her disease, but we can absolutely determine how we choose to face it.

I reassure her that I will be honest, even when it stings to tell her that despite the fact that she feels well, the metastases have grown a little. In turn, she tells me that she wants me to hide nothing but direct everything. “You’re the doctor and I trust you.” And every year for as long as she can, she will keep baking me the biscuits I have so grown to love.

“It’s a deal,” I say as another Christmas passes, each of us hoping to keep our end of the bargain for another year.