Five Women

by Rona Jaffe

  “Why do you want to do a reconstruction?” Gara asked, only out of curiosity, since she would never have opted otherwise.

  “You’re so thin that if you don’t do it you won’t be just flat, you’ll have a hole.”

  She obviously thinks I’m going to live for a while, Gara thought, if she wants me to look good. She felt rather encouraged.

  Dr. Beddowes handed Gara a piece of paper. “Here are the names of two very good doctors. One is kind of Hollywood and the other is very down to earth. See which one you like, and of course, see which one is free for the date of surgery. I’d like to have the surgery done as soon as possible because we waited so long. Next week?”

  “Give me two weeks,” Gara said. “I need to tell my patients I’m going away.” She would tell them she had to attend to personal matters and give them a referral doctor. It would be hard enough to deal with her own fears without having to deal with theirs. “How long will I be too sick to work?”

  “You’ll be in the hospital two days, and then you’ll be recovering for about five, and after that it’s up to you. You’ll have a drain in for two weeks.”

  Of the two recommended reconstructive surgeons Gara picked the Hollywood type, Dr. Lister, who wasn’t her idea of Hollywood at all except that she looked like a warmer Grace Kelly and was just as young as Gara’s other doctors. She had no idea what the down-to-earth doctor would have been like, but she didn’t have to make a choice because Dr. Lister was the only one available. She was happy with her decision. She felt as if she was in a sisterhood of bright young women. She didn’t want to be parented, she wanted to be a partner in her fight to live.

  “You’ll stay with us after you get out of the hospital,” Jane told her. “We’ll take care of you. You can stay as long as you want. You have the guest room.”

  “Thank you.”

  The surgery was set for a Monday, and she was to go to the hospital early that morning. She told Jane there was no point in coming with her; she would take a cab. She was nervous, and the few friends she had told were all calling her to wish her luck or to cry. Gara was glad they were concerned and cared about her, but she could hardly bear to speak to them. She just wanted to find her inner strength and be left alone. They were outside somewhere, and she had left their world. She would need them later.

  The night before her surgery, in her own apartment, in bed, Gara said goodbye to her breast. She looked for the last time at the sagging little thing she was so fond of and spoke to it silently. “You’ve served me well,” she said to it affectionately. “Remember all those nights in parked cars with college boys who just wanted to get their hands on you? We’ve been through a lot together, you and I, all these years.” She touched it gently. “Goodbye, and thank you.”

  Early the next morning at the hospital Gara found herself lying on a gurney outside her operating room, in a section where a man was lying on the gurney next to her, surrounded by his family—wife, son, daughter—waiting for his own surgery. The family kept kissing and comforting him and telling him they loved him. She wondered if they thought he would die. For the first time it occurred to Gara how alone she was. Carl was not there. They had no children. Her parents were no longer alive and she had no sisters or brothers to hold her hand. It felt odd, and she knew she had to put it out of her mind or she would feel sorry for herself, and afraid. After all, she had told Jane not to come. She could even have asked someone else. She had chosen to be this way. Was it bravado or not wanting to bother other people with her problems, bravery or her feeling of lack of entitlement?

  The wife looked at her. She seemed to feel Gara’s loneliness. “Are you here by yourself?” she asked.

  “Yes,” Gara said.

  “Well, I’m sure it will be all right. I wish you luck with your operation.”

  “Thank you.” They smiled at each other. Then Gara was wheeled into surgery.

  She woke up in a dim, pleasant hospital room with an I.V. attached to her right arm and the button for a morphine pump in her fingers. A searing pain on her left side near her ribs made her touch the button, and almost immediately she felt a little nauseated and completely out of pain. What a great invention, she thought. I don’t have to wait and beg. She slept. The next morning the nurse helped her wheel the I.V. to the bathroom, where she brushed her teeth and combed her hair. She was back in bed when Dr. Beddowes came to see her, her round face glowing with happiness.

  “They took out eighteen more lymph nodes,” Dr. Beddowes said. “There was nothing in any of them. You and I are going to grow old together.”

  Gara smiled back at her. How nice, she thought, we’re going to grow old together and she’s younger than I am. Then she realized that what her doctor was also saying to her was that she would be under care for cancer, even if it meant just checkups, for the rest of her life.

  “Can I have the I.V. taken off?” Gara asked Dr. Beddowes the next day when she came by. “It’s too hard for me to drag it around by myself. I could go on oral painkillers and antibiotics now.”

  “If you want. Your arm is going to be stiff, you know. You’re left-handed, so you won’t be able to brush your teeth or comb your hair for a while.”

  “I already did.”

  The next day she was walking up and down the hall with the nurse, counting laps. “If you keep doing this we’re going to throw you out,” the nurse said cheerfully.

  The day after that Jane took her home with her. “I thought you were going to be in a wheelchair,” Jane said, surprised, when she caught Gara emptying the dishwasher with her good arm. “Why are you doing things? We’re supposed to take care of you. Why are you on Tylenol? Why aren’t you on codeine? I never heard of anybody like you.”

  Gara knew why: she needed the independence, she needed the focus. Being mobilized and directed toward recovery would keep her from feeling too helpless and frightened.

  It hurt too much to sit up in bed from a prone position, so she used her bent leg to hold on to as if it were another person and hauled herself up. They had put a Johnson catheter inside her wound so it could drain, a plastic bag that somehow reminded her of a turkey baster attached to a long plastic tube, and she had to empty it several times a day and measure the fluid and write it down. Gara thought the worst part of the surgery was the drain. It hurt almost all the time. She pinned the tube to the top of her jeans and put the bag into her pocket, with a loose shirt over it. When she saw her patients she would pin it to her skirt. They would never know.

  The Breast Book became her Bible. After the first few nights, lying on her back, she tried reaching the headboard of her bed with her fingers, to keep her arm from stiffening. She couldn’t get anywhere near it, but she tried every day, and she could see the progress. She saw drawings of lymphedema, where the arm on the side where they had removed the breast and lymph nodes was swollen as a tree trunk, perhaps forever. That could happen at any time. Lymphedema itself could lead to cancer. You had to guard against infections, cuts, pricks; you couldn’t lift anything heavy or trim your cuticles. One more thing to be afraid of.

  What Gara was not afraid of was looking at the scar. She had already seen drawings of what it would look like, and she had never been squeamish about her own body, only her mother’s. When the bandages came off to be changed she was surprised to see a small breast-shaped hill on the side where she’d had the surgery. It was the expander under the muscle, to stretch the muscle and skin, and saline would be pumped periodically into a tiny invisible port in it to make it bigger. Her own breast was fifty-one years old, but the fake one looked only thirteen. Dr. Lister had already told her that eventually she would take care of that. If Gara wanted them to they could both look twenty.

  “When you’re healed we’ll start you on chemotherapy,” Dr. Beddowes said. “That will get rid of whatever tiny cancer cells might be floating around which we couldn’t see, if there are any. Because your case is r
ather unusual we took it to the cancer board. Two doctors wanted you on adriamycin, but I said that was overkill. I’m going to give you CMF, which is the standard in cases like yours. That’s Cytoxan, methotrexate, and 5–fluorouracil. You’ll get two injections a week apart, and then two weeks off, for six months.”

  She gave Gara three sheets of paper, listing the side effects of each chemical. The side effects all seemed awful and they all seemed much the same: hair loss, nausea, cracked fingertips, dark nails, mouth sores, fatigue, diarrhea or constipation, weight loss or weight gain, anemia. “You’re lucky that they’ve recently come up with an antinausea drug called Zofran,” Dr. Beddowes said. “It’s about a year old. The nurses will give you that in the I.V. before you get the chemo. Afterwards you might need a little Compazine, but I’ll give you a prescription. This new drug is a miracle.”

  They’re giving me poison, Gara thought, looking at the list. That’s what everybody says chemotherapy is. The poison will kill all the fast-growing cells like cancer and my hair follicles, but it’s also going to hurt the normal cells and make me sick. I don’t want to think of it as poison. I want to think of it as a good thing that’s making me well, and I want to help.

  “I want a hypnotist,” she said. “Can you recommend one?”

  Jane tried to persuade her to stay longer, but after ten days Gara needed to be home. Being healthy in someone else’s apartment she would have felt like a house guest, but fragile and recovering she was beginning to feel like a dependent child. She had a lot of work to do.

  When she was back home a woman came to visit her from the American Cancer Society. She, too, had once had a mastectomy. She sat on Gara’s couch, her face and voice so filled with empathy that she seemed to be making a condolence call. She made Gara nervous and Gara wished she would leave. The woman had brought an enormous pink cotton prosthesis that Gara couldn’t relate to at all, and a handful of polyester she could put into her bra. Gara took the polyester.

  “Did you have chemotherapy?” Gara asked.

  “No, I didn’t.”

  “Well, I already had a mastectomy so I know what that’s like,” Gara said, annoyed. “Why didn’t they send me someone who had chemotherapy so she could tell me what it’s like?”

  “I don’t know. They just send us wherever they send us.” She tried to be helpful. “When I had my operation they didn’t give chemo, but I’m sure if they did I would have had it.”

  “Oh,” Gara said, liking her better for trying.

  “Do you want to see my reconstruction?”

  “Sure.”

  The woman lifted her blouse and bra. There were two large, perfect breasts with perfect nipples on them. “My husband kept saying to the doctor, ‘Make them bigger, make them bigger,” she said, suddenly cheerful.

  “They’re beautiful.”

  “Thank you. Do you like your oncologist? What do you think of your treatment?”

  “I love my oncologist,” Gara said. She felt angry and defensive at these questions which she knew were solicitous and well meaning but in her mental state seemed controlling and intrusive. She realized for the first time how emotionally fragile she was. “I have a very good doctor and I’m very satisfied with my treatment,” Gara went on. “She knows what she’s doing.”

  She knew she was gibbering and that she sounded odd. We have to like our doctors, she thought. We have to have faith in them. It would be too terrifying otherwise. “Thank you for coming,” she said, rising. “I have to do some work now,” and hurried the woman to the door.

  Now it seemed that everywhere she went she met women who had recovered from breast cancer. Friends introduced her to strangers. “Stay away from all fat, oil, sugar, artificial sweetener, meat, cheese, white flour, and coffee,” one woman told her. She gave Gara a strict, healthy diet to stay on for the rest of her life, and at the end of a week Gara had lost seven pounds and looked bad. This, she knew, was no way to go into chemotherapy. She called Dr. Beddowes.

  “Give me a good nutritionist,” Gara said, “one who will let me eat anything I want.”

  The nutritionist, Rachel Smith, wearing a long flowered dress, sat in a small office surrounded by bottles of vitamins and plastic models of food. She had a bubbly personality, and she, too, looked forty. “Before you start on chemo eat the spiciest food you can find to toughen up your mouth,” she said. “Indian food. Curry. That will prevent mouth sores. Rub the inside of your mouth with lemon. My grandmother taught me that. Buy an electric toothbrush. Toughen up your gums. I want you to drink three quarts of liquid every day the whole time you’re on chemo; two of water and one of cranberry juice. The water will flush out the chemo fast and the cranberry juice will keep you from getting cystitis, which is a side effect of Cytoxan. Buy an iron skillet, the old-fashioned kind like your mother used. Cook steaks in it. You have to eat red meat three times a week. The iron gets into the food you cook and makes it better for your blood. They didn’t have anemia in the Wild West. Buy only free-range chickens, the kind that don’t have estrogen and antibiotics in them. I want you to eat six to ten ounces of protein every day, minimum.”

  “Coffee?”

  “Of course you can have coffee. I would die without it. I would prefer you didn’t drink diet sodas, but once in a while it’s okay.”

  “Chocolate cake?”

  “A little piece, not a big piece. There are only four things you can’t have. Tap water, margarine, which is full of poison and worse than a nice, natural piece of butter—they’re going to find out someday how bad it is—chemically decaffeinated coffee, which is treated with cleaning fluid; and raw fish. If you get sick from raw fish when your immune system is low you’ll never forget it.”

  Gara wrote it all down. She had found that her concentration was hazy lately. Rachel gave her a heavy bag of bottles of vitamins, which she sold to her at cost. There were some Gara had never heard of.

  “I want you to keep a journal of everything you eat and do every day and how you feel. That way we can see if any food disagrees with you, or if it’s just what’s happening in your life.”

  “That’s interesting,” Gara said.

  She looked surprised. “You didn’t know that?”

  Gara went to see the hypnotist, another young woman, who looked almost too young. She was, however, also a psychologist dealing specifically with cancer. Gara told her how she wanted to think of the chemotherapy and the hypnotist put her into a trance, which was surprisingly easy, and made a tape for her to play at home twice a day, and told her to take it to the chemo sessions if she wanted to. It told her to relax, and said that the medicine was helping her body to get stronger and healthier, and that her body was helping the medicine to work. Nowhere did it use the word “sick.” At the end it said that she would awaken refreshed.

  She lay on her bed and played the tape, and before it was finished she fell asleep. When she woke up it was over. She did feel very refreshed, and also relaxed, but she had missed the message. She called the hypnotist, concerned.

  “It’s okay if you sleep. The mind and body hear it anyway. And don’t listen lying on the bed.”

  They arranged for her to have a hypnosis session before each of her chemotherapy treatments, until she got used to them, and each time she would get the tape. She was feeling much more confident now, with her team of supportive female doctors making her a full partner in the task of saving her own life.

  She was back with her own patients now, the drain was out, and Jane had taken her to buy a wig just in case she needed it. As well as knowing the best plastic surgeons, Jane also knew the best place to get great hair. Gara had decided not to tell any of her patients she had cancer. Most of them were afraid of intimacy and afraid of being deserted, and she knew they would worry that she would die and leave them. Some of them might even react by becoming angry at her, and would stop their therapy. It would be too stressful for them to be
dragged into her personal life unless she actually were dying; in that event she would have to prepare them for it.

  And another factor was the income. She needed it now, more than ever, even though she had savings. Her quite inadequate private insurance had paid for the hospital immediately, but she didn’t know about the rest. The coverage didn’t include office visits and paid very little for surgery. This would be a long drawn out and expensive experience.

  Another acquaintance sent her to an acupuncturist who was supposed to tune up her system and make her balanced, therefore stronger. He was a tall dark-haired man in his forties with a small black beard. Sitting on a chair beside the raised cot Gara was lying on, he wanted to have a therapeutic conversation with her before he put the needles in.

  “Do you know why you got cancer?” he asked.

  “No.”

  “Stress.”

  “Then Carl gave me cancer,” Gara said, half in humor, half in bitterness.

  “Carl?”

  “My ex-husband.”

  “Wrong!” he said sternly. “You gave yourself cancer. You were stressed, you gave in to it. Don’t blame anybody but yourself.”

  Blame myself? Gara thought. I am the enemy within? That’s the last thing I need to think, that I’m walking around with a suicidal force inside me, that I can’t even trust myself.

  She got up. “Don’t bother with the needles,” she said quietly. “I’m leaving.”

  “I know I’m hard to take,” he said, “but you won’t face the truth.”

  She left. On the way home in the cab she realized she was shaking with anger, but she was also relieved that she had done something about her fury—taken action, walked away. There were so few times that she had done this. Usually she wanted to be conciliatory and polite.

  My cancer is not my fault, Gara told herself calmly and firmly. It’s nobody’s fault. It is what it is.

  It is what it is . . .

  That became her mantra. It soothed her. She knew a side effect of cancer was rage: at an interrupted life, at disease and pain and fear and loss and deformity and stolen time, at death itself. Rage and grief were natural. She would not let anyone add guilt. It’s not my fault. It is what it is.