Don't You Ever

by Mary Carter Bishop

  Ronnie had told me about mowing Maxine’s yard and doing chores around her house. He sounded like a new version of a tenant farmer to me, like our kin. As my mind raced for answers, I blamed Maxine for Ronnie’s troubles. I imagined that she’d held him in some nagging system of peonage, a free room for his labors, and he’d never been able to set himself free. She’d kept him from getting out and making the close friends who might have urged him to get help for his condition.

  Finally, with the breathing tube reinserted, nurses untied Ronnie’s hands. He couldn’t talk. His eyes were wild. He mouthed words I couldn’t make out. Eventually, we got him a pen and paper. He wanted me to know that he had health insurance and that he had $20,000 in Southwest Virginia Savings and Loan in downtown Roanoke. He must have thought he might die there in the hospital, because he was most determined to tell me that he had life insurance too and that he had cash hidden at Maxine’s house.

  I was keeping Mom posted. That Wednesday, Ronnie’s second day in the hospital, she and Daddy arrived at the ICU. It was their forty-eighth wedding anniversary and the first time they’d seen Ronnie in years.

  I was seated in a chair by his bed when they slipped quietly through the door. Over the heaves and sighs of the machines helping him, Ronnie heard his mother’s voice. Standing there in her mauve London Fog raincoat, she greeted him apprehensively, “Hi, Ronnie.” His eyes shot over to her, and to Daddy, standing beside her with his arms behind his back, hanging his head a little. I kept my eyes at the foot of the bed, at Ronnie’s blood pressure readout on the portable vitals cart. It was 200/215 and climbing.

  Ronnie was still smarting from the last trip he made to Mom and Daddy’s at Bridlespur in 1976. Daddy had asked him then, “Ronnie, what do you want?” Ronnie thought Daddy was implying he’d come to ask for money, which Ronnie had never done and was too proud to do under any circumstances. The question infuriated and humiliated him. I don’t think he confronted Early about it at the time, or ever, but Ronnie never forgot the perceived slight. I had asked my folks about that day. Both recalled Daddy asking the question. They insisted that what Daddy meant was “What do you want out of life?” That struck me as lame. Whatever Daddy meant, he should have known it would hurt Ronnie. The rip in Ronnie’s relationship with my folks widened even more after that.

  Now, in the ICU, I could feel that their presence was so stressful to Ronnie that it could kill him. My brother, who would only present himself to them in an optimal state—finest clothes, shoes shined, hair freshly cut, car waxed to high gloss, statuesque girlfriend by his side—was laid out there at his most vulnerable. He was in no condition to entertain the nemeses of his life. I had to get them out of there. I whispered that we should go. They, as well as Ronnie, were visibly relieved.

  That evening, Mom and I finally met Maxine and saw where Ronnie lived. We went to the house, as the doctors had suggested, to retrieve his wallet, his identification cards, and any documentation of health insurance. Ronnie also wanted me to gather whatever cash I could find and to keep it safe for him.

  I still didn’t trust Maxine. Why was Ronnie so nervous about leaving money in her house? But she actually seemed like a pleasant woman. She was short, plump, with reddish-brown hair and warm blue eyes. She unlocked Ronnie’s two rooms, which she referred to as his “apartment.” Clothes were piled four feet high around his bedroom. An interior doorway just past his disheveled bed led to the sort of kitchenette—refrigerator, small sink, stove—homeowners installed long ago so they could rent out a room. Ronnie had no bathroom of his own. He shared one down the hall with Maxine.

  Mom, still in her raincoat, followed Maxine and me silently into Ronnie’s chamber. Her mouth hanging open, her eyes rapidly blinking, she looked around at the filthy bed linens and the heaps of paper, trash, and shoes scattered around the floor. This was her child’s home, a dysfunctional, dirty mess.

  As Maxine looked on, I searched through a stack of down vests I’d spotted in a corner on the floor. Ronnie said he’d stashed money in a vest, but I found no money there. I grabbed the khaki pants he’d worn before the rescue squad came. Back at my house, I searched the contents of his pants pockets. I found his wallet, five driver’s licenses, some small folded papers, and $5,800 in cash. Ronnie had been walking around with more money than I’d put down on my house. That was the night I found the banded stack of Mom’s long-ago letters and birthday cards.

  Mom and I returned to the hospital for an evening meeting with the doctors. At a desk in a room down the hall from Ronnie, I lined up in chronological order the pictures I’d just found in Ronnie’s room: Ronnie at three, then at around twenty-five, then his driver’s license photos throughout the seventies and eighties. Snips of hair from Ronnie’s customers had wandered from his hands to his pockets and his wallet, and now they sifted down onto the desk. In the photos, we witnessed a painful march of bone and flesh across Ronnie’s face. One of the doctors quietly mumbled, awestruck, “Watch it grow.”

  We saw how the acromegaly gradually expanded his jawbone and lengthened his chin by inches. His forehead bulged; his lips blew up. What we couldn’t see in the photos was that his teeth had separated. His hands were widening. His middle fingers bulbed out at their tips like little lightbulbs. At age fifty-four, his feet were still growing. I made a mental note of the small mountain of old shoes I’d just glimpsed in his bedroom.

  A few years before the disease finally sent Ronnie to the hospital, a survey of acromegaly patients found that on average they lived with symptoms eight to ten years before they received a diagnosis. Ronnie had put up with warning signs for at least twice that long. His diagnosis came only when he nearly died.

  Usually a man Ronnie’s age had a wife and children to wonder why he kept outgrowing his shoes and why his facial features kept changing. Nearly everyone with the disorder seeks help and halts its progression. That’s why Ronnie, with late-stage acromegaly, was so unusual. The youngest doctors standing beside Mom and me in the hospital that night had only read about acromegaly in textbooks. They’d never seen it in person, much less such an advanced case.

  They explained to us that when a person develops a pituitary tumor before puberty, the legs and arms keep growing and the patient might become a giant. Ronnie may have been as tall as six foot five at one point—his height measurements vary throughout his records—but he was not a giant. He was an Overstreet, and we tend to be tall. His tumor came along after puberty, when the long bones of his limbs had fused. Therefore, his overgrowth concentrated in the bones of his hands, feet, and face and in his organs and soft tissues.

  Quickly I was absorbing the medical reasons for two of Ronnie’s traits that long had baffled me—that deeper-than-ever voice and his persistent joint pain. Acromegaly reshapes the larynx, deepens the voice, and enlarges air cavities in the cranial bones, all of which gave Ronnie’s voice a deep, gravelly, hollow-sounding resonance, a basso profundo that boomed as from the bottom of a well. Between customers in the barbershop, he would flex his shoulders violently—shoulders in, shoulders out, like a bird repeatedly pushing back its wings. Now I learned that painful overgrowths at the shoulders, hips, knees, and back are common with acromegaly.

  * * *

  MOM HAD BEEN in such a rush to leave home that day that she’d forgotten to grab her Ativan, the antianxiety drug she’d become addicted to since she was forced off Bridlespur eight years earlier. One of the doctors called in some to my pharmacy so she could sleep that night. With all this terrible news about Ronnie, she was a wreck. She stumbled around my house like a zombie, groaning as though she hurt, and then she blurted out, “Mary Carter, I told you who Ronnie was.” When I was little, she’d revealed to me that he was my brother, but I was too young to understand. She never mentioned it to me again.

  Mom and Daddy drove back to Charlottesville the following morning. From then on, it was just Ronnie and me, side by side in the hospital for the next thirty-seven days. In between his medical crises, whenever the plast
ic tube was out of his throat and he could talk, he spat out more of his story, and I began to deal with my conflicting feelings about him. I was fascinated with Ronnie the story. But what about Ronnie the man?

  * * *

  I THOUGHT EVERYTHING would get better now that he’d been diagnosed. That’s the way doctors were laying it out for us. That, I guess, was what they were hoping for.

  On his fourth day in the hospital, after the tracheal tube came out without complications and he could talk again, I began to share with him what I was learning about his hormonal disease. Doctors had explained the basics to me, and now I was reading about it on my own at lunchtime—at the newspaper and in the library. It was believed that only forty people in a million worldwide had it.

  Ronnie stared at me, expressionless, as I explained his symptoms to him and the solution the doctors were proposing.

  A pituitary neurosurgeon could take most of the tumor out fairly easily, not by cutting into Ronnie’s head but by threading a slender instrument through his nose or under his upper lip to reach the pituitary through the sphenoid sinus behind his nose. I told Ronnie that once the tumor was plucked, his feet and hands would stop growing. Some of the soft-tissue growth, such as that of his heart, larynx, tongue, nose, and lips, would gradually subside. He would breathe more easily; he would sleep more soundly. His protruding brow, however, and his long jaw and his big hands and feet were permanently his.

  Most urgent was the need to get the tumor out and away from his optic nerve. Doctors were warning that the tumor was already pressing on the nerve. A few more nanometers of tumor growth could snuff out the paired optic nerve to his eyes and blind him instantly. Heroic notions swirled in my brain. I was going to make up for all the neglect of his life. I was going to save him. I would compensate for my childless years and become the mother he’d never had.

  Ronnie had listened patiently. Then I heard the first inklings of denial welling up in him. “Oh, I’m getting better. It’s not that bad.” Yes, he acknowledged, his shoe size had crept from 12 to 13 to 14, but he thought his feet were no longer growing so quickly. He was pleased about that. It wasn’t easy finding shoes larger than size 14.

  Ronnie’s many doctors, especially the gland specialists, the endocrinologists, were in and out of his hospital room for five weeks. They studied his blood hormones; they looked at his tumor through magnetic resonance imaging, and with his permission, they photographed him. To them, Ronnie was a medical star. Ronnie would ask intelligent questions of them. He’d listen to them earnestly. Then, as soon as they were out of earshot, he’d turn a jaded face to me and laugh. “This is all a bunch of bullshit.”

  One day, a visiting pituitary specialist came to his room and laid out a plan. I was excited. At that time, no surgeon in Roanoke had the experience to remove the tumor. So their first idea was to send him for surgery at George Washington University Hospital in Washington, D.C.; Ronnie nodded. He seemed receptive to the idea. But as soon as the doctor left, Ronnie smart-assed to me, “Yeah, then Ethiopia, Bangkok, and Zululand.”

  Going to some big city for surgery struck Ronnie as a high-flown lark. Out screeched a smart-ass voice of my own: “Slim, they’re trying to help you.”

  “Yeah, easy for them to come up with all these cockeyed schemes. Won’t be their ass going up there to be cut on.”

  He privately spouted a bouquet of reasons for his symptoms. He simply looked like the people of Appalachia, who seemed odd to city people but whose ugliness was common in the mountains. Or he’d explain away his condition by saying simply, “I’m a freak.” One of his doctors was black. Ronnie said he identified with the man. “I know what it’s like to be the only one who looks like me in a room.”

  Then there was Ronnie’s most bizarre theory, mentioned to me more than once: Somehow all his ailments were a conspiracy to punish him for not taking sides in that fall’s vote on a merger of Roanoke City with Roanoke County. Ronnie recalled a female teller at the bank across from the barbershop laughing and telling him, “Well, you won’t be driving long.” Ronnie interpreted her remark as some sort of threat from the Vinton establishment. This was so crazy that I had no comeback.

  Nor did I have one for the most heartbreaking explanation he offered for his condition: “I just look like my old man, whoever the hell he was.”

  * * *

  THAT AFTERNOON, I rode with him in an ambulance to an imaging center a mile away. Doctors needed to confirm that he had a pituitary tumor and to measure its proximity to other vital structures inside his head. The radio waves of magnetic resonance imaging could reveal in detail all the features inside his skull.

  As the heavy door to the MRI room closed solidly behind Ronnie and the aide who would position him, the technician invited me to sit with him in the control room. Through a wide, thick window into the MRI room, I watched the aide’s difficulty getting Ronnie to lie flat on the scanner bed. Ronnie yelped in pain. His mangled right hip and leg, healed crooked after a long-ago fall off a railroad trestle, made it agonizing for him to recline on a hard surface. But for images to be captured clearly, he needed to lie there and hold himself still for quite a few minutes. Once Ronnie settled down, a nurse injected him with Magnevist, or gadopentetate dimeglumine, a drug that clarifies images of abnormalities inside the cranium.

  At the control panel, the technician wasn’t allowed (or qualified) to tell me what the pictures were showing on the monitor, although he did point out the pituitary. In images of Ronnie’s head taken straight ahead and to the side, I saw an irregularly shaped lump clinging to the tiny gland. After all these years, the tumor was only the size of a Coca-Cola cap. It measured 3 × 2.5 × 2.2 centimeters, large among acromegaly patients.

  A few days later, a radiologist’s report confirmed what all Ronnie’s symptoms, his blood tests, and his startling appearance had already indicated: Ronnie did have acromegaly.

  * * *

  BACK IN HIS hospital room, Ronnie told me he thought he recognized one of the MRI guys as somebody he’d seen in Vinton. The man was yet another character in Ronnie’s conspiracy theory. He seemed to think he’d been kidnapped by the rescue squad and was being held captive at the hospital. Now I was questioning Ronnie’s sanity.

  He bragged to me about “riding the MRI.” It was hot inside that tubelike machine. It banged and clattered like a jackhammer. “I did it to satisfy a whim,” he said with teasing annoyance. “Yours.”

  He wasn’t buying any of this crap about some mumbo jumbo called acro-whatever-it-was.

  “You know they’re just trying to help you, right?” I said.

  Ever the wise guy, he replied, “Help themselves to my bank account, you mean.” I was the spoiled kid who trusted people; he was the neglected kid who didn’t.

  Ronnie might have been paranoid, but his irreverence often made me laugh. The fervent Christians who swarmed the hospital especially got his goat. A young Baptist preacher grasping a Bible made his proselytizing round on the ward one day, asking Ronnie, “Have you surrendered to the Lord for your salvation?”

  “Naw,” Ronnie shot back lackadaisically. “Haven’t gotten around to it.”

  * * *

  DURING THOSE WEEKS in the hospital Ronnie told me the worst things from his childhood. That was when he told me our mother warned him at age eight, after he arrived in Keswick, never to call her Mama. That was when he told me he had electroshock therapy at Western State. Every night I went home with ever darker information about him and about my family. That I was aghast at all this surprised Ronnie. “I never thought you’d give a damn about me,” he said, giving me the rare look straight in the eye.

  “You know,” I told him, “I owe you for all the good stuff that’s happened to me. You were her first kid. She wanted to do better the second time. I got everything you didn’t.”

  He snorted. “You got that right.”

  * * *

  MY OPENING UP like that unlocked his trust, as well as his mouth. Some days he talked to me for
five hours straight. When the nurses bathed him or took him away for tests, I’d go to the waiting room at the end of the hall and write down everything he’d said.

  * * *

  AFTER RONNIE’S FIRST week in the hospital, I’d already listened to him so many hours that I was exhausted. I was home only long enough to feed my cats and sleep a little. I was overidentifying with Ronnie. I’d seen every square inch of him by then, and my feet, legs, all of me, felt like his. We shared the enlarged, arthritic Overstreet knees and the long, thin thighs of our mama and our grandpa. I felt Ronnie’s brow superimposed over mine. He and I shared the same sour smell of our oily skin. Even my sebaceous glands were kin to Ronnie’s.

  I was determined not to abandon him in the hospital. Martyr-like, I was appropriating our mother’s guilt in not caring for him. Here was a chance to use my reservoir of nurturing on my mixed-up brother.

  At times while taking Ativan for his anxieties, he became docile and even lovable. He expressed sincere thanks to the nurses. “Thank you, dear,” he’d say as they padded in and out. Some of them and the youngest doctors had been afraid of him earlier when he’d pounded those giant hands on the side rails.

  One of his many symptoms was a thickening of skin on his heels. It was a wrestling match to get those tight rubber-bottomed hospital socks over his oversized heels. He thanked me for doing that and for bringing him little tubs of sherbet from the fridge at the nurses’ station.

  * * *

  IT HADN’T YET been three years since I first reconnected with Ronnie, and I hadn’t told him much about myself. In the hospital, I began to fill in the details. For instance, Mom had never told him why they’d left Bridlespur. I explained that Anne McIntyre Black had fired Daddy and evicted my folks from the farm.

  “Mom had kind of a nervous breakdown. We couldn’t get her off the couch. She’d lie there for hours and just cry. Remember what a speed demon Uncle Albert was? They took a little trip with him right around then. Mom was in the back seat and could see the speedometer. She had a panic attack in a little town. They thought she was having a heart attack and pulled over. She saw a doctor who put her on Ativan. She’s tried and tried to get off it, but she’s never been able to.” Ronnie was hanging on my every word.