by Janny Scott
Ann’s compensation for her job in Jakarta had included health insurance, which covered most of the costs of her medical treatment. She had even had a physical in order to qualify—an examination she said had required six separate office visits in Jakarta. Once she was back in Hawaii, the hospital billed her insurance company directly, leaving Ann to pay only the deductible and any uncovered expenses, which, she said, came to several hundred dollars a month. To cover those charges as well as living expenses, she filed a separate claim under her employer’s disability insurance policy. That policy, however, contained a clause allowing the company to deny any claim related to a preexisting medical condition. If, during the three months before starting work, a patient had seen a doctor or been treated for the condition that caused the disability for which they later wanted coverage, the insurance company would not compensate the patient for lost pay.
In late April, a representative of the insurance company, CIGNA, notified Ann that the company had begun evaluating her disability claim. (According to CIGNA, the disability policy was underwritten by Life Insurance Company of North America, a subsidiary of CIGNA.) In the meantime, the representative suggested that Ann find out if she was eligible for benefits under the Social Security system. Ann had already been told by Social Security Administration officials in Honolulu that she was not eligible: She had not earned enough credits in the previous ten years to be eligible for Social Security disability income, and she was ineligible for benefits under the Supplemental Security Income program for disabled people with limited resources because she owned an asset worth more than $2,000, an Individual Retirement Account. In response to the letter from CIGNA, Ann sent back copies of letters from the Social Security Administration and a half-dozen other documents that CIGNA had requested, along with a four-page letter that included a detailed chronology of her illness. “During the three months before joining DAI, the only doctor I consulted was Dr. Barbara Shortle, a New York gynecologist,” Ann wrote in the letter. “Dr. Shortle gave me a routine annual examination in May 1994, including pap smear and pelvic exam. She sent me to a laboratory for a mammogram and pelvic ultrasound. On the advice of the radiologist of the laboratory, I also had a breast ultrasound. None of these tests indicated that I had cancer. The pelvic examination indicated that I had an enlarged uterus, but this is a condition which I had had for about five years previously.”
Ann’s letter did not mention the one procedure, the dilation and curettage, she had omitted to have.
By late June, CIGNA had made no decision on Ann’s disability claim. The company was waiting to hear from Shortle, a representative told Ann. Ann faxed a letter to Shortle, whom she had not seen since her appointment thirteen months earlier. She explained that she was being treated for ovarian cancer in Hawaii and that her disability claim had been held up for months while CIGNA investigated whether her cancer was a preexisting condition. She said she had given Shortle’s name to CIGNA, which, in turn, had faxed Shortle a request for information. Two weeks later, CIGNA sent another letter to Ann, addressed this time to “Mr.” Dunham. Among other things, the letter said, “If we do not receive either the requested information or some communication from you within 30 days from the date of this letter, we will assume you are no longer claiming benefits under your Long Term Disability Plan.”
In one of several drafts of a response to CIGNA, Ann coolly leveled a pointed objection.
Since I have sent you a mountain of forms and a lengthy letter dealing with my illness, which is ovarian cancer, I am surprised that you are not aware that I am a woman. I realize that it is unusual for a woman to have a man’s first name, but I have signed my correspondence to you with my middle name of Ann. Also we have spoken by phone within the last month. Combined with the fact that my claim has been pending for five months, I am forced to wonder whether it is receiving proper attention.
In mid-August, CIGNA denied Ann’s claim on the basis of her visit to the New York gynecologist two and a half months before she started work in Jakarta. Shortle’s office notes had indicated that she had formed a working hypothesis of uterine cancer, though Ann said Shortle never discussed that hypothesis with her. When I spoke with Shortle, she said it was quite possible that she had not told Ann of her suspicions. “Whenever you do a D and C on any woman who has bleeding on and off, you’re always doing it to rule out uterine cancer,” she said. But, she said, the procedure can be therapeutic as well as diagnostic. She might not, at that point, tell a patient her thinking.
Ann requested a review of the denial and informed CIGNA that she was turning over the case to “my son and attorney, Barack Obama.” Years later, during the presidential campaign and even after his election, Obama would allude to his mother’s experience, albeit in an abbreviated form, when making the case for health care reform. Though he often suggested that she was denied health coverage because of a preexisting condition, it appears from her correspondence that she was only denied disability coverage.
Ann, characteristically, had hoped for the best. If all went well, the chemotherapy would be completed by the end of August, after which it would take two months for the side effects to abate. “Then, assuming that I go into remission and there is no recurrence of the disease, I should be able to return to work in November,” she had written to CIGNA in May. Because she would need monitoring and regular blood tests, it would be difficult to take a long-term overseas assignment again. “Instead, I plan to do short-term assignments for DAI which will allow me to return to Hawaii for checkups in between,” she wrote.
When friends called on the telephone, Ann often sidestepped the subject of her illness. In a series of conversations with Madelyn’s youngest brother, Jon Payne, they sparred jokingly for the title of black sheep of the family, wondering why they had allowed themselves to fall so far out of touch. To Made Suarjana, calling from Bali, Ann insisted she was fine. He began to notice, however, that her voice sounded different. Slamet Riyadi, a colleague from Bank Rakyat Indonesia, was uncomfortable even asking about her health. Instead, he told her he would pray for her. Dick Patten came away from one telephone conversation believing that Ann had beaten the cancer. Julia Suryakusuma received a letter from Ann, which she allowed herself to understand, only later, had been intended to let her know that her friend was dying. When Rens Heringa called from Los Angeles on a visit from the Netherlands, Ann implored her to fly to Hawaii, but Heringa could not. Ann made it clear to Heringa that she knew she would never get better. Why was she forcing herself to continue with chemotherapy? Heringa wondered. Ann refused to give up hope. “Even when she knew she was seriously ill, it was probably not a matter of denial but really believing she was not ready to die,” Suryakusuma said.
Ann Hawkins, whom Ann had first met fifteen years earlier in the mountains above Semarang on the north coast of Java, understood that Ann was extremely ill. With some people, Ann seemed to keep the conversation light so she could think about happier things, Hawkins told me. But she spoke honestly with Hawkins. “She didn’t really talk about her life,” Hawkins remembered. “Except that I always had the sense that Ann felt very privileged. She felt, yeah, of course her life was cut short. But at the same time she had an extraordinary life. . . . And I think she knew that. I think she showed it, in how she treated other people. She felt such abundance—that’s the word—in not only her own life but life all around.”
Hawkins extended her arms out in front of her, palms turned upward.
“I see Ann sort of like this, with her hands out, giving,” she said. It was a gesture, she said, of generosity, perceptiveness, and compassion.
In early September, Ann said good-bye to her friend Georgia McCauley, whom she had known since her days at the Ford Foundation with McCauley’s husband, David. In their weekly visits over the previous months, the two women had talked often about their children, rarely about Ann’s illness. Now the McCauleys were moving. “It was difficult, because we both sort of knew that we wouldn’t be seeing each other,” G
eorgia McCauley remembered. Ann indicated that she believed Barack would be fine: He was happy, and Ann thought Michelle would be a good partner. “She was just worried about Maya,” McCauley remembered. “‘Will you take care of Maya? Keep an eye out for Maya.’
“She was saying something pretty profound,” McCauley told me. “But it was sort of like the end of a conversation, as you’re leaving. Nobody wants to face the obvious.”
Ann had told McCauley many times that she did not want her children to see her in the state she was in. But in the weeks that followed, McCauley said, “I often wondered, maybe I should have called Barry and bugged him. I asked Maya to talk to him. I said, ‘You all need to realize that it’s going to happen fairly soon.’ But I didn’t know him well enough. I just thought it was kind of presumptuous for me to tell him what to do. I know they spoke. It’s a difficult issue to deal with.”
In mid-September, Ann and Madelyn flew to New York City for a series of appointments at Memorial Sloan-Kettering Cancer Center, widely considered the most respected cancer center in the country. An oncologist at Sloan-Kettering had agreed to give Ann a second opinion. Maya, working full-time as a student teacher while in graduate school, met her mother and grandmother at LaGuardia Airport. Ann emerged from the terminal in a wheelchair, looking dazed and startled. Madelyn, a month away from her seventy-third birthday, was suffering from severe back pain. They were carrying with them Ann’s medical records, X-rays, and tumor slides. They settled into the Barbizon Hotel on the East Side of Manhattan, near the hospital. Barack, back from his book tour and one week away from announcing his candidacy for the Illinois State Senate, arrived from Chicago with Michelle. At the first of two appointments at Sloan-Kettering, Ann was given a physical examination; she turned over the records to the doctor and the tumor slides for reevaluation by the pathology department. Then she returned to the hotel to wait.
Maya and Ann walked in Central Park, bought frozen yogurt, wandered among the glittering displays of smoked fish and cheeses at Zabar’s, the legendary food store on Broadway on the Upper West Side. They watched a movie of no particular interest to either one of them, Maya sitting next to her mother, holding her hand. When it was over, Maya asked Ann what she thought of the movie. It was a good distraction, she said, from the turmoil inside. Years later, Maya would remember her uncertainty about how best to help her mother—whether to encourage her to talk about what she was feeling or simply to be with her. If she could just get through the semester at New York University and at the school where she was teaching, Maya thought, she could fly home to Hawaii and stay with her mother as long as she was needed.
On September 15, 1995, the oncologist saw Ann for a second time. On the basis of the reevaluation of the tumor cells and the pattern of the illness, he believed Ann’s cancer was uterine, not ovarian, and stage four, not stage three. He recommended that Ann’s physician in Honolulu switch to a chemotherapy regimen based on a different drug, Adriamycin, or doxorubicin. The survival rate for women in Ann’s condition was poor, he said, and sixty percent of patients did not respond positively to the drug he was suggesting. But if it worked, Ann might hope for a delay in recurrence and a period relatively free of symptoms.
Back in Honolulu, the new treatment proved grueling. Arlene Payne’s conversations with her niece became shorter and shorter. Ann had never been inclined toward regrets. If she regretted anything now, it was not having left Indonesia sooner to get medical care, Payne told me. “But she fought it for as long as she could. Then she sort of gave up and just sort of lived out the rest of her life.” The United Nations Fourth World Conference on Women in Beijing came and went. From the point of view of Women’s World Banking, it had gone well. Much of the language hammered out in the report of the expert group on women and finance, in which Ann had played a central role, had been incorporated into the action plan endorsed by the delegates in Beijing. Hillary Rodham Clinton, then the First Lady, had spoken on a panel on microfinance that Women’s World Banking had helped organize. For the first time, microfinance seemed to have emerged front and center in the world’s attention. Nina Nayar, Ann’s young protégée from Women’s World Banking, returned from China via India, then flew to Honolulu to see Ann. Ann’s mane of dark hair was gone. But she was ornamented, as always, for the occasion. “The turban becomes you,” Nayar marvelled affectionately. “I think it’s even more majestic.” As Nayar recalled that visit, she and Garrett Solyom hoisted Ann into a wheelchair and set off on one last field trip. After all, it was Nayar’s first visit to Hawaii. They picnicked at sunset and tried Ann’s favorite Hawaiian foods. At Ann’s insistence, they made their way up to the Nu‘uanu Pali State Wayside, where the trade winds climb the windward cliff of what remains of the Ko‘olau volcano and roar through the Pali Pass as though through a funnel. There, not far from the tunnels that carry traffic through the mountain and from one side of O‘ahu to the other, there is a panoramic view of the green Nu‘uanu Valley, Kaneohe Bay, and the beach town of Kailua. Struggling with the wheelchair against the wind and trying to keep Ann’s headgear from taking flight, Nayar remembered, she and Solyom maneuvered Ann into the optimal spot. “It was the same feeling as we had on top of the pyramid,” Nayar said. “It was probably a parting gift for both of us.”
In early November, during a collect call to her mother on a pay phone near the NYU campus, Maya noticed that Ann sounded momentarily confused.
“You know what, Mom?” she later recalled saying. “I’m coming. I’ll work it out. I’ll do whatever papers I have left. I’m coming. I’ll see you there very soon.’
“She said, ‘Okay,’” Maya remembered. “And I told her I was scared. And she said, ‘Me, too.’ And then, ‘I love you.’
“And that was it.”
On November 7, Maya flew to Honolulu, unsure of what she would find. Ann was unconscious and emaciated. To Maya, she appeared to be starving. But she was alive, as though she had waited. Maya took Madelyn’s place by Ann’s bed in the hospital room so that her grandmother could go home. Then she talked—about all that Ann had given her, about how she would be remembered with love. Maya had brought with her a book of Creole folktales, which she had been reading with her students as part of a study of origin myths. She began reading aloud. In one story, a person was transformed into a bird. Then the bird took flight.
“I told her finally that she should go, that I didn’t want to see her like that,” Maya remembered. “And she was gone about fifteen minutes later.”
For Barack, not being at his mother’s bedside when she died was the biggest mistake he made, he would say later. He was at home in Chicago when he got word. He had last seen Ann in New York City in September, and had last spoken to her, he told me, several days before her death, before she lost consciousness. “She was in Hawaii in a hospital, and we didn’t know how fast it was going to take, and I didn’t get there in time,” he told the Chicago Sun-Times in 2004.
Word spread quickly. Dick Patten got the news in Burma, where he was working on a project for the United Nations Development Programme—trying to help the Burmese people, as he would later put it, without helping the Burmese government. Don Johnston, whom Ann had discreetly nudged into domestic happiness, got the news in Indonesia in the field. Made Suarjana, at his typewriter in his office in Bali, wept when Maya called. In a private ceremony, he told me, his family offered prayers to help deliver Ann’s spirit to the next world. In Colorado, Jon Payne asked the priest in his church to include his niece in the congregation’s prayers. After all, as far as Payne could tell, Ann had been doing what Christians always said saints did—helping people. “She wasn’t a particularly religious person, if at all,” Payne said. “But she did more things for people than a lot of Christians do.”
In Jakarta, Julia Suryakusuma made an impromptu altar out of a table and a Balinese mirror in the living room of Gillie Brown’s house on Jalan Gaharu in Cilandak. She placed a photograph of Ann in the center, along with candles, flowers, wood carvings
, ikat, and traditional Indonesian cookies and cakes. Like an offering, Suryakusuma told me. She sent around flyers announcing a memorial gathering for Ann. On the afternoon of November 13, two dozen friends turned out. There was a period of silence, followed by a guided meditation, with music, led by an Australian yogi (“a lot of stuff that Ann privately laughed at,” Don Johnston told me, chuckling). Wahyono Martowikrido, the archaeologist who had helped introduce Ann to the mysteries and meaning of the patterns in Javanese textiles and the shapes of silver jewelry, and Johnston, the Southern Baptist from Little Rock, Arkansas, were there. So was Ong Hok Ham, the historian, and Yang Suwan, the anthropologist, and several Indonesian women who had tried to start an Indonesian affiliate of Women’s World Banking. There were women from Ann’s team at the Ministry for the Role of Women. There were messages sent by Bruce Harker; Sabaruddin, Ann’s driver; and others. After the guided meditation, Ann’s friends regaled one another with memories of and stories about her. When everyone had drifted away, Gillie Brown sat down and wrote a letter to Madelyn, Barack, and Maya in Hawaii, listing everyone who had turned out in Jakarta. “The spirits of all these people will be with you in Hawaii today, as you say your farewells to Ann,” she wrote.
In Honolulu, they gathered in the Japanese garden behind the East-West Center, the institution that embodied, more than any other, the spirit of the time in which Ann had come of age and the values by which she had lived. They convened near the stream, whose rambling course beneath the monkeypod trees was intended to signify the progress of a life. The group of several dozen included Madelyn Dunham, Maya and Barack, Michelle, Alice Dewey, the Solyoms, Nancy Peluso, Ann Hawkins, Michael Dove, Benji Bennington, and others—close friends from graduate school, the East-West Center, Jakarta, Yogyakarta, Semarang, Pakistan, and New York. They, too, recounted recollections of Ann. Then they drove east out of Honolulu to the Kalaniana‘ole Highway, the road that winds along the wind-whipped southeastern coast of the island of O‘ahu. They followed it, past the turnoff for Hanauma Bay, to where the coastline turns wilder and great slabs of rock tilt toward the indigo water. At a scenic lookout, they parked and got out. Beyond a low wall built of volcanic rock, the ledges descended toward a distant point the shape of an ironing board jutting into the surf. There, gripping each other against the wind, Barack and Maya carried the ashes of their fifty-two-year-old mother across the water-slicked rocks and delivered them into the rough embrace of the sea.