The Instant When Everything is Perfect

by Jessica Barksdale Inclan

  Robert sits back in his chair, shaking his head. Right. His parted twin walked in into one of his exam rooms, just like that. Maybe it was just that the daughter seemed like someone who would never ask for a procedure as trivial as a forehead peel or liposuction or a chin implant? Someone who would never swish into his office, sit down, and talk about having a “little cosmetic maintenance.”

  He doesn’t know what his reaction was all about, but when he’d seen her—what was her name? Had he written it on the chart?--she reminded him of a taste, something like caramel, rich and thick and sweet.

  For the first time that day, Robert Groszmann, M.D. is excited to see a patient.

  He tries not to look at the daughter, Mia Alden, too often. He is conscious of focusing on Sally while she talks, nodding, blinking once, twice, and then turning to Mia for a quick, natural affirmation of Sally’s words. Mia is never looking at him, her eyes on Sally’s face, but he can tell that she sees his glance, her peripheral vision catching his gaze. Her face seems flushed, high colored. He looks back at Sally, listens, wondering how old Mia is. Her skin shows, as the current lotion ads say, the signs of aging. Small crow’s feet by her eyes, the slight grooves running from her nose to lips, lines that will slowly deepen with time. But she has no eyelid droop, no need for a Blepharoplasty; no excess skin under her chin. She’s had no work done, not ever.

  She’s not wearing a wedding ring, and there is no tan line where one should be. But her last name is different than Sally’s. So maybe she’s divorced or separated. Robert stares at his chart, wondering what went wrong with her marriage. Or, he thinks, she just doesn’t wear a ring. A choice? She’s not old enough to be a hippie, throwing out all social norms. Perhaps she just took it off for today, to send him a message.

  She’s got to be thirty-eight. Maybe forty?

  “So what do you think?” Sally glares at him, her dark eyes glinting.

  Robert pushes his hair back, blinks, reads the actual words he wrote on the chart, and then looks up. “What I’m hearing you say is that you do not like the way a mastectomy deformity looks.”

  “God no! All those lumps and bumps in the wrong places.”

  “Those people,” Robert says, “were fat. Overweight. Considerably. You wouldn’t have a result like that.”

  Mia laughs, shifts in her chair. “Lucky it’s you and not me, Mom.”

  Robert swallows, unable to believe he said the word fat. Why not obese? Overweight? Clinical terms. He glances at Mia, who is still blushing.

  Sally waves her hand. “It’s just so ugly. But I can live with it until I heal from the first surgery. Then I want it done. An A cup, just like we discussed.”

  Robert writes down what she says, knowing that the appointment is just about over. He won’t see Sally Tillier or Mia Alden for months now, not until after Sally has had her mastectomy, undergone chemo or radiation treatments, and healed. Maybe, as sometimes happens, a woman as practical and conscientious as Sally Tillier would decide that her mastectomy deformity is quite livable, doable, the prostheses just fine. With her new bra and the soft, malleable prosthetics, no one knows her secret. She could walk and travel and even date without anyone knowing. After the cancer, the idea of additional surgery, further hospitalization and office visits and worry might seem ridiculous.

  Robert might get a call or a message from Sally, saying she’s changed her mind. Or she might just never call again, the idea of even stepping in the building too much to bear.

  Robert taps his pen on the chart, nodding. “I think that’s the right decision for you. I do want to do a few additional measurements before you leave.”

  “Should I tell Dr. Jacobs?”

  “I’ll let her know,” Robert says, thinking of Sally’s surgeon Cindy Jacobs, her slightly befuddled gaze, her sturdy, competent hands. Sally has the best surgeon she could possibly have, and Robert wonders if Sally knows that. “She’s a wonderful surgeon, and we’ll talk more extensively after your surgery.”

  Mia stands up, and Robert’s heart begins to speed up, a trill of adrenaline along his sternum.

  “I’m going to go to the waiting room,” she says, picking up her jacket. “You don’t need me for this.”

  She smiles at her mother and then turns to Robert. Her eyes are—yes, they’re amber, caramel, the color of the taste in his mouth.

  “Thank you, Dr. Groszmann,” she says and then she opens the door, walks out, and closes it softly behind her.

  Sally sits up and unties the front of her gown, turning her head away to look at the wall. “She’s a writer, you know.”

  Robert slides his chair closer to her, pulling his tape measure from his right pocket. “Really? What does she write?”

  “Novels. She’s in the paper all the time. Once she was on Good Morning, America.” Sally’s pulse beats so fast in the hollow of her neck, Robert wants to put his index finger there to calm her. Instead, he focuses on his tape measure, collarbone to nipple, nipple to nipple. Aureole dimension, chest wall, clavicle.

  He rolls up his measure and puts it back in his pocket, pushing back toward the sink in his chair and washing his hands. “Can I get your daughter’s books at any book store?”

  Sally pulls her gown tight around her. “Oh, yes. Amazon dot com. Barnes and Noble. Borders. She lives in Monte Veda and the bookstore there has her on constant display. Home girl makes good and all. But her stories are more—well, they might be geared more for women.”

  So am I, Robert wants to say, but doesn’t. He is geared for women but only temporarily, for short quick bursts and then he’s alone with his cat.

  He moves away from the sink and looks at Sally Tillier. “You’ve thought about the type and stages of reconstruction?”

  Sally nods. “What about that TRAM flap thingy?”

  Robert shakes his head. “It won’t work for you. You’re too thin. Not enough material to work with.”

  Opening her mouth, Sally looks up at him, but then whatever words she had disappear. She shrugs. “Well, maybe by the time we do this, silicon will be back. Those breasts looked a bit more, well, real. I guess they feel more real, too.”

  “Some people think so.”

  He stands up and throws the paper towel in the garbage. “Sally, it’s been a pleasure. I think you will be very happy with your choice. We will be in touch in a few months. I wish you the best with your surgery and treatment.”

  Robert takes her hand, shakes it, feeling her nerves and blood tingling in her palm.

  “Thank you, doctor,” she says. “You’ve been very helpful.”

  Robert smiles and then leaves the office, Sally’s chart held tight against his chest. The moment he’s out in the hall, Carla comes over to him, notes in her hand, messages from five patients (Jackie Lagalante already?), a consult needed in dermatology and the ER, stat, messages from Drs. Jacobs, Sengupta, Cho, Walters. And in no time at all, Sally Tillier and Mia Alden leave his mind, cancer and novels and all.

  “Rob, listen. You’re not seeing the big picture,” Jack Slater says, sitting back in the booth at Primo. Robert has known Jack since their first year of college at Berkeley, back when Jack was skinny and acne prone. Now, thanks to Accutane and Club Sport Athletic Club, he’s the joy of all his female patients.

  They’ve finished a very late dinner, and are now drinking brandy. Jack used to work for Inland where Robert works still, but has since moved on to a private practice, seeing patients in a large, royal suite of offices in Alamo, an expensive bedroom community.

  “What picture would that be?” Robert is used to Jack’s largesse after a huge meal, his expansive discussion, his sweeping comments, his need to try to understand Robert. Jack always wants to talk about big ideas, turning each and every conversation into proof of how Jack has lived his life one hundred percent right and how all Robert has to do is hurry and catch up.

  “Our work. It’s art. It’s the intersection of art and science. How people look reflects how they feel inside. If you change t
heir appearance, you can change their soul.”

  “Oh, Christ. Jack! Do you hear yourself? If you feel that way, you have a demented God complex. If you want to do art, go get a potter’s wheel. What we do is about helping people.”

  Jack sips his drink, smiling. “Helping them do what? Feel better about themselves?”

  “Yeah.”

  “So if they feel better about themselves, doesn’t that affect their psyches, their souls?”

  Robert pushes his hair back and shakes his head. “If I reattach someone’s finger, don’t you think that person will be better about himself than he did the moment the jigsaw cut it off?”

  “Maybe. But he’s only had his finger off for, what? An hour tops? A woman with a big nose or huge jaw will have had that since birth. Her whole personality has been formed based on the fact of this defect. She’ll have learned to hide it. She’ll have endured teasing. Think what’s been affected? Her self-esteem, self-love, self-value. She will have found ways to relate to lovers based on it. Rightly or not, her parents may have even treated her differently because of it. So when I do a rhinoplasty, I can take away her need to hide, to fear, to loathe. I lift that dark shroud off her personality. I change her.”

  “But patients don’t seem to know where to stop,” Robert says. “And some of us don’t either. The line is so blurred between what is necessary and what is almost a crime. If we aren’t working with people who are sick, who truly need us, how can we call ourselves doctors? How can we even talk about what we do when there are those ultimate makeover shows?”

  “The outer and inner are the same,” Jack says, smiling broadly, the old conversation having arrived at his favorite curve. “To work on the average or ugly or annoying outer is the help the inner made sick because of it.”

  Robert’s stomach churns. He’s heard this argument his whole career, even believed it himself for long stretches before something or someone would rip an enormous hole in it. For months and often years, he would be lulled by the idea that he was helping people, perfecting them, giving them the lives they really wanted. Then, in an instant, as he stood over a patient sucking out micro bits of fat from her face, he would see that he was perpetuating the shallow, superficial view the entire world seemed to be embracing these days, giving false hope, covering up reality, pandering to an impossible view of beauty.

  And then? And then something really awful happened.

  “Do we,” Robert says, putting down his glass, “always have to talk about work?”

  Jack raises his eyebrows, and Robert knows that he shouldn’t have tried to change the subject.

  “What else is there?” Jacks says. But he’s smiling.

  “Oh, I don’t know. Your family. Tina. The state of the economy. Our new governor. Anything.” Anything but Leslie, Robert thinks.

  Jack sighs. “God, I wish we could smoke in here.”

  “A cigar might start a riot.”

  “You’re right.”

  “About what? The riot or the conversation?”

  “Both. Listen, what’s going on with Leslie? You haven’t said a word about her.”

  Robert shakes his head. “You couldn’t help yourself, could you?”

  Jack rolls his eyes. “What? You think that you can avoid this conversation? I know we’ve had it before a few times, but Rob. Shit. Tell me what happened this time.”

  “You’re trying to kill me, aren’t you? You want me dead. You want all my patients.”

  “I don’t need your patients. I want your house. And if you don’t ever hook up with another woman, I’ll be your next of kin. Don’t forget to tell your lawyer.”

  Robert takes his last sip and pushes the glass away. “Leslie and I didn’t work out.”

  “She was a great girl. I see her sometimes at the gym.”

  For a second, Robert looks around for the waiter, needing another drink. The waiter sees him and pretends not to, turning his back, too close to closing time offer up another drink. Robert sighs.

  “She wanted different things. She—“

  Jack snorts. “Don’t tell me. She wanted a commitment. You know, a relationship. God forbid, marriage?”

  “Not everyone is as lucky as you are. Not every woman can be Tina.”

  “Even Tina isn’t Tina sometimes. No one is perfect, Rob.”

  “Haven’t you said you are?”

  Jack thrums the table with his fingers and glares in mock anger at Robert. The waiter walks up and clears away the empty glasses, a spoon, mumbles something, and leaves the check. Jack takes it, and Robert lets him because it’s his turn.

  “Well, you could give a woman longer than a year. Or give yourself longer. You might actually get used to her.”

  “I . . .” Robert starts and then stops. Jack stares at him, and Robert looks at the table cloth flaked with bread crumbs. He wants to finish the sentence, but he knows it will sound corny, especially to Jack.

  “You could try to get over this strange year thing you’ve got going. Push through to thirteen months or so and see what happens, you might just grow accustomed—“

  “Don’t you dare start singing that song from My Fair Lady,” Robert says, holding up his hand. During procedures, Jack listens to musicals—Oklahoma, South Pacific, Camelot—and belts out the tunes he loves best.

  “I’ve grown accustomed . . .” Jack begins.

  Robert tosses a sugar cube at Jack. “Knock it off.”

  “I’ll stop when you have someone to grow accustomed to.” Jack throws the cube in the middle of the table and then hands the check back to the waiter.

  Robert pushes his hair back and spreads a hand on the table top, noticing pepper in between his fingers. “I did meet someone interesting this week.”

  Jack’s eyes widen. “Really? Where?”

  “A patient’s daughter. She even sent me a thank you card. But—“

  “But what? It’s not like you’d be dating a patient. She’s a patient once-removed. No infringement on the Hippocratic Oath. No sexual harassment policy broken. No code of conduct infraction.”

  Robert rubs her forehead. “It won’t work. It can’t, and I did something not great. I plugged her into Inland’s database and looked her up. She’s a member. Married. Two kids. A husband. She must have eczema, too. Scripts for Elidal and Valisone.”

  “You are a little twisted,” Jack says, taking the check back from the waiter, signing the slip, and putting his credit card back in his wallet. “Good to see. I didn’t know you had it in you. You usually wait for a woman to find you and bang you over the head with a club and drag you back to your cave.”

  “Funny.” Robert stands, taking his jacket off the chair and tucking in his shirt.

  “So what else did you find out? What other confidential info did you expose?” Jack gets up too, and puts his wallet in his pocket. He and Jack put on their coats and walk through the dining area to the door, pushing out into the evening. They stand side by side, facing the street. A valet takes Jack’s ticket and disappears.

  “So?” Jack asks.

  “One of her kids was in the rehab program.”

  “I hope it worked,” Jack says. “Are you sure it wasn’t her?”

  “It said adolescent program in her file.”

  “I hope she’s older than that. Otherwise, we’ll have to have dinner on visiting days at Santa Rita.”

  The valet drives up with Jack’s Porsche Carerra, and Jack hands him a five dollar bill. “Come on, I’ll drive you to your car. I can’t believe you still won’t pay for a valet.”

  Robert shakes his head and holds out his hand to shake Jack’s. “No, I’m going to walk up to Bonanza Books. I need something to read.”

  Jack takes Robert’s hand and then pulls him to him, giving him a hug. Jack laughs, the familiar, comforting sound in Robert’s ear.

  “Try to avoid spying on anyone else this month. And stay away from married women.”

  “Like you ever did.” Robert pulls back, pats his friend’s arm.
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