by Rona Jaffe
“I look like the Bride of Frankenstein,” she said happily. “But I don’t care. My husband keeps saying he’s just so glad I’m alive. We had planned to grow old together and that’s all we want.”
That was all I wanted too, Gara thought, saddened.
The other woman was in her late thirties, and she and her husband wanted to have a baby, so she had opted to have a mastectomy and chemotherapy instead of a lumpectomy and radiation. She hadn’t bothered to be reconstructed, and her husband didn’t mind. She had a prosthesis, an expensive artificial breast and nipple that she had sent for separately from a catalogue, to match her own. She glued them on. Her breasts looked very perky. She and her husband were still trying to start their family.
“The worst part was the chemotherapy,” she told Gara. “They didn’t have the antinausea drug then and I had to smoke grass to keep from throwing up. We got a drug dealer. My husband and I would sit around the apartment getting stoned. I don’t know what I would have done without it.”
“I guess each of us is happy with her choice of what kind of reconstruction to have,” Gara said.
“Oh, yes,” they agreed enthusiastically.
She tried not to let herself think that she was the only one of them who was going through all this alone, who had no one to say he was just glad she would still be there. I am glad for myself, she told herself. I want to live.
She went to physical therapy, where she worked on apparatuses to regain the mobility of her left arm and shoulder. At home she practiced all the time.
“When am I going to be through with this?” she asked.
“When you can do this,” the therapist said, swinging her arm in a big circle, showing her.
“You mean this?”
“You did it!”
“You never asked me,” Gara said.
“I’ve never had a patient who sprang back as fast as you did,” the physical therapist said. “I’m embarrassed to discharge you until the end of the week, so can you keep coming back anyway till then?”
“Yes, if you’ll massage the scar.”
Afterward her nutritionist sent her to a personal trainer who was experienced with postsurgical patients, and would go with her to the gym and train her three times a week throughout the chemotherapy so she would be strong. He was big, young, and muscular, and while she pedaled the stationary bike he told her about his problems with his girlfriend and Gara gave him professional advice. She also, of course, had to pay him, although he did not pay her.
She was impatient to start chemo, to save her life, to be clear and clean. The chemotherapy was given in a windowless room in her doctor’s office, painted a drab beige, with fluorescent lighting overhead, and a raised desk in front for the nurse. There was a row of beige leather lounge chairs for the patients, with IV stands next to them. No music, no plants, no daylight, nothing. It was claustrophobic and depressing. She willed herself not to be afraid.
The first time she went to chemo Gara made Jane come with her because she didn’t know what physical reaction to expect, but after that, when she knew nothing debilitating would happen, she was, as always, the only patient who arrived alone. The other women came with solicitous husbands or daughters, who whispered to them in the waiting room and then waited patiently outside for them to be finished, to take them home. Gara played her hypnosis tapes on a Walkman, read People magazine, drank cranberry juice the nurse brought her. She willed the slender veins on the back of her right hand to come up, full and ready for the tiny needle, told them not to hurt. They hurt anyway.
Sometimes she was the only one in the chemo room, and sometimes there were other women, cheerfully taking off their uncomfortable hats to reveal pale bald heads, offering home-baked chocolate chip cookies, chattering to other women they knew; or silently hunched into themselves, frightened and miserable, wondering about their lives. There were the ones with the I.V.’s in their hands and the ones with the shunts in their chests, whose veins were used up. There were the ones, like Gara, who still had hair. After a while, even those who had been friendly fell silent, because the process took a long time, and because, no matter how brave they were, they all knew why they were there.
She knew her schedule. Right after chemo she went directly to the gym and worked out, full of energy. She looked very white. The next morning she woke up flushed and healthy-looking. The third day she was too tired to get out of bed. It was not a sick and exhausted tiredness, it was a kind of calm lethargy. The least thing seemed too much effort. She arranged her patients’ appointments accordingly.
After she had been on chemo for a month her hair started falling out in an unstoppable cascade every time she combed it, fluffy piles in the bathroom sink. “It’s falling out,” she told Jane in despair.
“You know what?” Jane said. “I have a friend in Los Angeles who had chemotherapy for breast cancer, and I just remembered she bought some kind of scalp treatment she could put on at home and it helped a lot. I’ll call her and find out for you. California has everything new, organic and mystical. If they don’t have it, who will?”
So now Gara got up an hour earlier every morning to apply her scalp treatment, which stained all her towels beyond repair and made her hair fall out a great deal less. The hair that was left looked stringy and burned, and people who didn’t know why told her she should stop going to her dreadful hairdresser, whoever he was, and find another one, but at least she didn’t have to wear the wig. Somehow that was a kind of triumph to her.
Between the exhaustion and the things she had to eat and drink and the exercise and meditation and tapes to listen to and chemo sessions and doctor’s appointments and blood tests and the hours she spent on her regular work, there was no time to think of anything else. Concentrating on herself was not selfish, it was good sense. These days, during that fall and winter, Gara almost always spent Saturdays and Saturday night with Jane and her husband, stayed up late talking, and sometimes slept over so they could have breakfast together, as if they were her family. During the week she saw a few friends for dinner sometimes, and still went to parties when she felt up to it, although the sight and smell of wine made her sick; and when she was at those parties people told her how happy she looked. They did not tell her she looked drawn and gray-faced, although she knew she did.
“You’re the bravest person I’ve ever known,” Jane told her. “Eliot thinks so too. He said, ‘I don’t know when Gara cries. She must, sometimes.’”
“I don’t,” Gara said. “I don’t know why.”
“And you’re cheerful! I know I wouldn’t be if it happened to me. I would be hysterical and sobbing.”
“Nobody knows how they’re going to react to an emergency until it happens,” Gara said.
She and Jane made jokes about her disease, which in their opinion had opened the door to entitlement. Life was too short to put up with bullshit anymore. Never would Gara have to spend time with another bore, go where she didn’t want to, suffer fools gladly, be hypocritically polite. “I don’t have to do that,” she and Jane would say, and add in a whiny voice, “I have cancer.” Then they would laugh.
People told her she seemed happy, and the odd thing was that she was happy. She tried to figure out why.
Well, she had been given a reprieve, for one thing. Her doctor told her she had a seventy-five-percent chance of living a normal life span; that was what statistics said. This was the first time in her life when everybody and everything was focused on her well being and survival; her doctors—all those good-mother figures, young enough to be optimistic, old enough to be wise—praising her fortitude and stamina, explaining away her fears, even hugging her. It was not a return to infancy, since her own mother had been too protective and she had been helpless; rather it was both protection and collaboration.
Yet now, sometimes, for long moments until she made herself stop, Gara missed May. She missed her more than sh
e missed Carl. May would have been at her side every moment, bringing her things she needed. May had liked it when Gara had been sick, had made her stay home from school at the slightest cough, put her to bed, fed her.
But Gara also remembered that she had hated missing school and not being with her friends, and that unless she was really sick she had felt trapped. If May were here she would have worried about Gara too much, made her be too brave in the wrong way, would have tried to take away all her painkillers after the mastectomy because May was afraid of painkillers and refused to take them herself. May would have bitten back sobs of grief and fear and made Gara turn into the one who comforted the other, pained by her mother’s pain, frightened of her mother’s “weakness,” because May prided herself on the fact that she never cried.
Gara wondered if she was like her mother after all. May felt it was too personal, too cowardly, too embarrassing to shed tears in front of other people, even her family. May ate not only to avoid sex but also to sedate herself. Is that why I never cried when I heard I had cancer, Gara asked herself, and not ever, not once, through this whole ordeal? But I never needed to, she remembered; I never even thought of tears. No, she thought, I am not like my mother. I am independent. May never was independent because she had me.
Cancer had changed her, made her see life in a new, better way. It was a cliché but true: when you wanted to live more than anything else in the world, you realized how trivial everything else was.
But that was until the bills started coming in. We do not pay for injections, the computer printout from Blue Shield announced when her large chemotherapy bills came back to her unpaid.
Gara called to protest. “You’re not covered for office visits,” the woman on the phone said, sounding bored and irritated. “Look at your policy. We don’t pay for injections.”
“This is chemotherapy!” Gara said. “Not just injections. I need it to save my life.”
“We don’t pay for injections.” Now the woman sounded angry, as if she spent all day talking to protesting, unreasonable idiots who thought having paid enormous premiums gave them the right to anything.
Gara knew she should write a letter to someone with more authority, or even get a lawyer to explain it for her, but exhausted and drained from the chemo Blue Shield refused to cover, she put it off. She was too immobilized to fight or even to let herself get angry. I’ll do it when I’m well, she thought, thankful she could afford to pay it on her own.
The expander under her chest muscle deflated. There was a leak. Luckily it was only saline, which had been absorbed harmlessly. When Dr. Lister tried to fill it up, it deflated again by the next morning. She told Gara it had never happened to anyone before. The company that manufactured the defective expander wanted it back for tests when it would eventually be removed for her reconstruction, when she was well enough. But now, when Gara looked in the mirror, on one side she saw a flat chest with a washboard of wrinkled skin where it had been stretched, like the chest of some ancient man, and on the other side the remainder of what she used to be. I guess I won’t go out on a blind date again for at least a year, she told herself, resigned. Even I can’t stand to look at it, and it’s mine. She bought a latex breast to put in her bra. It looked and felt real, but it fell out every time she bent over.
She finished her six months of chemo in time to celebrate the New Year. It was just in time, because the pads of her fingers had begun to split and bleed from the methotrexate. Her last session it took an hour and a half to find a usable vein in her hand; the others had collapsed. Her bravery had collapsed too: she couldn’t make the veins stand up, she couldn’t push away the pain in her hand, her fingertips stung; seeing the blessed end in sight, she just wanted it to be over. Her nails were bluish black, her hair was thin and pathetic, her eyebrows almost nonexistent, her three or four eyelashes not worth putting mascara on, but she had never had mouth sores, never been nauseated except at the gym, never had cystitis, had maintained her weight, and she was going to be ready soon for reconstruction. Her drawn and grayish face looked fifteen years older, but nobody ever mentioned it. Why would they?
Gara scheduled her first reconstruction to take place over the Easter holiday, so it would seem normal to her patients (and everyone else) for her to “go away.” She was starting to look better. She’d had her destroyed hair cut off in the very short little-boy bob she now noticed on so many middle-aged women who were not waif models, and which suddenly seemed to hint of secrets she had never before suspected. It’s the chemo cut, she thought to herself; does she or doesn’t she?
The surgery was done under general anesthesia because Gara’s plastic surgeon had to make a pocket for the implant underneath the chest muscles, and she felt it would be too painful under a local. “It’s not like breast augmentation,” Dr. Lister had said. “It’s much more precise, because you don’t have a breast to go over it and cover up any imperfections of placement.” Dr. Lister had chosen silicone for her despite the furor that was currently surrounding it. “If a patient has a breast to go on top of it, I use saline,” she said, “but it’s too wrinkly and bouncy for you. If you had saline your breast would look like a pool toy.”
“A pool toy!” Gara said, and she had to laugh. “But is silicone safe?”
“I’ve taken silicone implants out of women who’ve had them for thirty years,” Dr. Lister said. “They’re very strong, and they don’t leak. The ones that used to kill women were when doctors put shots of silicone directly into their breasts, in little clumps, and it would wander to their lungs and organs. There really is no proof that the new one’s cause autoimmune disease. Since the lawsuits, only one company has been chosen to manufacture silicone implants now, and to get one for you I have to put you on a protocol. All that means is you come in for checkups, which you would do anyway.”
“But what about the women who did have problems and won their lawsuits?” Gara asked.
“I still think you’ll be safe.”
“Okay,” Gara said, because she really wasn’t afraid.
The company who made her implant was the same one that had manufactured her expander. They examined it carefully and had no idea why it had been defective.
After her surgery Gara went to Jane’s, enjoyed being pampered for a few days, and then went home, impatient to be independent. She had a drain again, but this time she didn’t mind, because it was temporary, and she also had a round young breast, which was permanent. A nipple would have to be made later, sculpted from her chest skin, and the nipple and aureole would be tattooed to duplicate her real one in color. This was a new technique and Gara was glad they had discovered it; formerly the nipple had been made from a little piece cut from the patient’s vulva, and the very idea made her cringe. Why hurt in two places when you could hurt in only one? She would also have to have her real breast lifted so they would match.
The artificial breast sat on her chest like half an orange, because that was its nature, while the real one looked deflated. Now Gara was putting the polyester she had saved into her bra on the right side. In the summer, when she had her month off, Gara had her remaining breast lifted and rounded to match it to the new one, and a small saline implant put in to complete the transformation. Before all this happened it would never have occurred to her to have her breasts lifted; it seemed too vain, something for a movie star to do, but now that she’d had it done she wondered why she hadn’t done it years ago. They still didn’t really match, and they weren’t quite the same height, but those changes would be made later in yet another operation.
“They never match the first time,” Dr. Lister said. “If you’d had a double mastectomy they would be perfect, but there are just too many variables when one is real.”
It takes one operation to lop it off, Gara thought, and six to put it back on.
Blue Shield refused to pay for either of her hospital stays for reconstruction, with various excuses ranging from
not paying for plastic surgery to incomplete information about the dates she had been in the hospital and how many pieces of equipment had been used. She was covered as an inpatient, and they kept insisting she had been an outpatient. She immediately started to worry, even though she kept telling herself it was bad for her health not to stay calm, and the worry increased. There were delays, letters sent back and forth, repeated phone calls made by Gara to people whose names she wrote down and couldn’t reach again, who kept asking for hospital and surgery records the hospital insisted had been supplied and which they said they never received. She went higher up and finally found a woman who she was able to talk to every time, but it did no good anyway, except that this one acted nicer. The hospital accused the insurance company of lying and delaying, and the insurance company accused the hospital of the same thing. Now Gara had copies of her records, of files, of correspondence, but she still owed thousands of dollars and she wasn’t even finished with all her surgery.
Every month the hospital sent her bills with increasingly stern computer printouts on them. “Hospital bills are your responsibility,” they kept reminding her. “We will have to take legal measures.” She knew she had the coverage; it said so in her contract. Why didn’t her insurance provider provide it?
Finally, after a year, when the hospital thought she was a deadbeat and she was too stubborn to prove to them otherwise, they wrote to her and threatened to send a collection agency to get their money from her, to take away her home, her car, to ruin her credit rating. Sometimes now she found herself trembling with rage at the injustice of all this bureaucracy, because it was being used against people who had been ill and still feared for their lives, and because many of them really had no money and were probably terrified.