Maybe You Should Talk to Someone_A Therapist, HER Therapist, and Our Lives Revealed

by Lori Gottlieb

  The phrase made her smile. It could work both ways, she decided. How many times do good things inexplicably come our way too? Just the other day, she told me, some random person walked into Trader Joe’s with a homeless woman who’d been sitting in the parking lot and said to Julie, “See that woman over there? I told her to buy herself some food. When she gets to the register, come find me and I’ll pay the bill.” Relating the story to Matt after work, Julie shook her head and said, It was just one of those things.

  And, in fact, on her next try, Julie got pregnant again. Baby Y was going to have a younger cousin this time. It was just one of those things.

  So as not to jinx it, Julie didn’t nickname the baby. She sang to it and talked to it and carried around her secret like a diamond that nobody could see. The only people who held the secret with her were Julie’s husband, her sister, and me. Even her mother didn’t know yet. (“She has trouble keeping good news to herself,” Julie said, laughing.) So it was me to whom she reported her progress, me to whom she described the heart-shaped balloon that Matt had brought to their first-heartbeat ultrasound appointment, and me whom she called when, a week later, she miscarried again and tests revealed that Julie’s uterus was “inhospitable” due to a fibroid she would need to have removed. Again, a welcome problem because it was so common—and fixable.

  “But at least I don’t have cancer,” Julie said. That had been her and Matt’s other refrain. No matter what happened—all the daily annoyances big and small that people tended to complain about—as long as Julie didn’t have cancer, all was right with the world. Julie just needed a minor surgery to get rid of the fibroid, and then she could try to get pregnant again.

  “Another surgery?” Matt had said.

  He worried that Julie’s body had gone through enough. Maybe, he suggested, they should adopt or use a surrogate to carry the baby with the embryos they’d frozen. Matt was just as risk-averse as Julie—this had been a point of commonality when they met. With all of her miscarriages, wasn’t that a safer idea? Besides, if they went the surrogate route, they had the perfect person in mind.

  On the way to the ER during her recent miscarriage, Julie had called Emma, a coworker at Trader Joe’s, to see if she could cover Julie’s shift. Unbeknownst to Julie, Emma had just signed up with a surrogate agency so that she could pay for college. Emma was a twenty-nine-year-old married mom who wanted to get a college degree, and she loved the idea of giving a family their dream as a way to make her own educational dreams come true. When Julie confided in Emma about her uterus problem, Emma instantly offered her services. Earlier, Julie had encouraged her to go back to school, even helping her with college applications. She and Emma had worked side by side for months and it never occurred to Julie that Emma might one day be pregnant with her child. But if her question in life had always been Why?, this time she asked herself, Why not?

  So Julie and Matt came up with a new plan, as they’d had to do so many times since the beginning of their marriage. She would get her fibroid removed and attempt one more pregnancy. If that didn’t work out, they’d ask Emma to carry their baby. And if that didn’t work out, they’d try to become parents through adoption.

  “At least I don’t have cancer,” Julie had said in my office after she finished explaining the baby setback and the plan forward. Except that while preparing for her fibroid removal, Julie’s doctors discovered the fibroid wasn’t the only issue. Her cancer was back, and spreading. There was nothing they could do. No more miracle drugs. If she wanted, they would do what they could to prolong her life as long as possible, but she would have to give up a lot along the way.

  She was going to have to figure out what she could live with—and without—and for how long.

  When the doctors first presented this news, Julie and Matt, sitting side by side in vinyl chairs in a doctor’s office, burst out laughing. They laughed at the earnest gynecologist, and then the next day they laughed at the solemn oncologist. By the end of the week, they had laughed at the gastroenterologist, the urologist, and the two surgeons they consulted for second opinions.

  Even before they saw the doctors, they were giggling. Whenever the nurses, escorting them to an examination room, asked rhetorically, “How are you two today?” Julie would reply nonchalantly, “Well, I’m dying. And how are you?” The nurses never knew what to say.

  She and Matt found this hilarious.

  They laughed, too, when presented with the possibility of removing body parts where the cancer might grow most aggressively.

  “We have no use for a uterus now,” Matt said casually while sitting with Julie in one doctor’s office. “Personally, I’d vote for keeping the vagina and losing the colon, but I’ll leave the colon and vagina up to her.”

  “‘I’ll leave the colon and vagina up to her’!” Julie guffawed. “He’s so sweet, isn’t he?”

  At another appointment, Julie said, “I don’t know, Doc. What’s the point of keeping my vagina if we remove my colon and I’ve got a bag of poop attached to my body? Not exactly an aphrodisiac.” Matt and Julie laughed then too.

  The surgeon explained that he could create a vagina out of other tissue, and Julie burst out laughing again. “A custom vagina!” she said to Matt. “How about that?”

  They laughed and laughed and laughed.

  And then they cried. They cried as hard as they’d laughed.

  When Julie told me this, I remembered how I had burst out laughing when Boyfriend said he didn’t want to live with a kid under his roof for another ten years. I remembered the patient who laughed hysterically when her beloved mother died, and another who laughed when he learned that his wife had multiple sclerosis. And then I remembered sobbing in Wendell’s office for entire sessions, the way my patients had and the way Julie had for the past few weeks.

  This was grief: You laugh. You cry. Repeat.

  “I’m leaning toward keeping my vagina but dumping the colon,” Julie says today, shrugging, as if we’re having a normal conversation. “I mean, I just got fake breasts. With a fake vagina, there won’t be much difference between me and a Barbie doll.”

  She’s been figuring out how much has to be taken away before she’s no longer herself. What constitutes life even if you’re alive? I think about how people barely talk about this with their elderly parents, all the would-you-rathers that they’d rather not contemplate. Besides, it’s all a thought experiment until you’re there. What are your deal-breakers? When your mobility goes? When your mind does? How much mobility? How much cognition? Will it still be a deal-breaker when it actually happens?

  Here were Julie’s deal-breakers: She’d rather die if she could no longer eat regular food or if the cancer spread to her brain and she couldn’t form coherent thoughts. She used to believe that she’d rather die if she had poop traveling through a hole in her abdomen, but now, she just worries about the colostomy bag.

  “Matt’s going to be repulsed by this, isn’t he?”

  The first time I saw a colostomy in medical school, I was surprised by how unobtrusive it was. There’s even a line of fashionable bag covers adorned with flowers, butterflies, peace signs, hearts, jewels. A lingerie designer dubbed them “Victoria’s Other Secret.”

  “Have you asked him?” I say.

  “Yes, but he’s afraid of hurting my feelings. I want to know. Do you think he’ll find it repulsive?”

  “I don’t think he’ll find it repulsive,” I say, realizing that I’m being careful with her feelings too. “But he may have to get used to it.”

  “He’s had to get used to a lot,” she says.

  She tells me about a fight they had a few nights ago. Matt was watching a show, but Julie wanted to talk. Matt was uh-huh-ing her, pretending to listen, and Julie got upset. Look what I found on the internet, maybe we can ask the doctors, she said, and Matt said, Not tonight, I’ll look tomorrow, and Julie said, But this is important and we don’t have a lot of time, and Matt looked at her with an anger she’d never seen in him
before.

  “Can’t we have one night off from cancer?” Matt yelled. It was the first time he had been anything but kind and supportive, and Julie, taken aback, snapped at him. “I don’t get a night off!” she said. “Do you know what I’d give for a night off from cancer?” She fled to the bedroom and closed the door, and a minute later, Matt followed, apologizing for his outburst. I’m stressed, he said. This is very stressful for me. But not as stressful as what you’re going through, so I’m sorry. I was insensitive. Show me the thing on the internet. But his words shook her. She knew that it wasn’t just her quality of life that was changing. Matt’s was, too. And she hadn’t been paying attention to that.

  “I didn’t tell him about the thing on the internet,” Julie says. “I felt so selfish. He should get a night off from cancer. This isn’t what he signed up for when he married me either.”

  I give her a look.

  “Well, sure, the vows say ‘in sickness and health’ and ‘for better or worse’ and all that, but that’s kind of like clicking okay to the terms and conditions when you download an app or sign up for a credit card. You don’t think any of that is going to apply to you. Or if you do, you don’t expect it to happen right after your honeymoon, before you’ve even had a chance to be married.”

  I’m glad that Julie is thinking about the impact of her cancer on Matt. It’s something she’s avoided talking about by changing the subject whenever I mentioned that maybe it was hard for Matt to go through this too.

  Julie would shake her head. “Yeah, he’s amazing,” she’d say. “He’s so solid, so there for me. Anyway . . .”

  If Julie had any awareness of the depth of Matt’s pain, she hadn’t been ready to face it. But something shifted with Matt’s outburst, forcing her to acknowledge a difficult tension: their togetherness on this unfortunate journey, but also their separateness.

  Julie is crying now. “He kept wanting to take back what he’d said, but it was already out there, hanging between us. I understand why he wants a night off from cancer.” She pauses. “I’ll bet he wishes that I would just die already.”

  I’ll bet sometimes he does, I think for a second. It’s hard enough in a marriage to do the give-and-take of putting one’s wants and needs aside for another, but here the scales are tipped, the imbalance unrelenting. Yet I also know it’s much more complicated than that. I imagine that Matt feels trapped in time, newly married, young, wanting to live a normal life and start a family, all the while knowing that what he has left with Julie is temporary. He sees his future as a widower, then as a father in his forties rather than his thirties. He probably hopes that this doesn’t go on for another five years, five years at the prime of his life spent in hospitals, caretaking his young wife whose body is being cut apart. At the same time, I’ll bet that he is touched to his core by this experience, that in some ways it makes him feel, as one man told me in the months before his wife of thirty years died, “forever changed and paradoxically alive.” I’d wager that, like that man, Matt wouldn’t choose to go back in time and marry a different person. But Matt’s at a life stage when everyone else is moving forward; the thirties are a decade of building the foundation of the future. He’s out of sync with his peers, and in his own way, in his own grief, he probably feels completely alone.

  I don’t think it would be helpful for Julie to know every detail, but I believe that their time together will be richer if there’s space for Matt to show more of his humanity during this process. And if they can have a deeper experience of each other in the time that they have left together, Julie will live more fully within Matt after she’s gone.

  “What do you think Matt meant by wanting the night off from cancer?” I ask.

  Julie sighs. “All the doctor appointments, the lost pregnancies, everything I want a night off from too. He wants to talk about how his research is going and the new taco place down the street and . . . you know, the normal things people our age talk about. The whole time I’ve been going through this, all we cared about was finding a way for me to live. But now, he can’t make plans with me for even a year from now, and he can’t go meet someone else. The only way he can move forward is if I die.”

  I hear what she’s getting at. Underlying their ordeal is a fundamental truth: For all of the ways that Matt’s life has changed, it will eventually return to some kind of normal. And that, I suspect, pisses Julie off. I ask if she’s angry with Matt, envious.

  “Yes,” she whispers, as though she’s sharing a shameful secret. I tell her it’s okay. How could she not be envious of the fact that he gets to live?

  Julie nods. “I feel guilty for putting him through this and jealous that he gets a future,” she says, adjusting a pillow behind her back. “And then I feel guilty for being jealous.”

  I think about how common it is, even in everyday situations, to be jealous of a spouse and how taboo it is to talk about that. Aren’t we supposed to be happy for their good fortune? Isn’t that what love is about?

  In one couple I saw, the wife got her dream job on the same day that her husband was let go from his, which made for extreme awkwardness every night at the dinner table. How much should she share of her days without inadvertently making her husband feel bad? How could he manage his envy without raining on her parade? How noble can people reasonably be expected to be when their partners get something they desperately want but can’t have?

  “Matt came home from the gym yesterday,” Julie says, “and he said that he had a fantastic workout, and I said, ‘That’s great,’ but I felt so sad, because we used to go to the gym together. He’d always tell people that I was the one with the stronger body, the marathon runner. ‘She’s the superstar, I’m the wimp!’ he’d say, and the people we became friends with at the gym started calling us that.

  “Anyway, we used to have sex a lot after the gym. So yesterday when he gets back, he comes over and kisses me, and I start kissing him back, and we have sex, but I’m out of breath in a way I’ve never been before. I don’t let on, though, so Matt gets up to shower, and as he’s walking into the bathroom, I look at his muscles and think, I used to be the one with the stronger body. And then I realize that it’s not just Matt who’s watching me die. It’s me, too. I’m watching myself die. And I’m so angry at everyone who gets to live. My parents will outlive me! My grandparents might too! My sister’s having a second baby. But me?”

  She reaches for her water bottle. After Julie recovered from her initial cancer treatment, her doctors told her that drinking water flushes out toxins, so Julie began carrying a sixty-four-ounce bottle everywhere she went. Now it’s no longer useful but it’s become a habit. Or a prayer.

  “It’s hard to see what’s still there,” I say, “and to let it in when you’re grieving for your own life.”

  We sit in silence for a while. Finally, she wipes her eyes and the slip of a smile forms on her lips. “I have an idea.”

  I look at her expectantly.

  “You’ll tell me if it’s too wacky?”

  I nod.

  “I was just thinking,” she begins, “that instead of spending my time being jealous of everyone else, maybe part of my purpose for the time I have left could be helping the people I love to move forward.”

  She shifts on the couch, getting excited. “Take Matt and me. We won’t grow old together. We won’t even grow middle-aged together. I’ve been wondering if, for Matt, my death will feel more like a breakup than the end of a marriage. Most of the women in the cancer group who talk about leaving their husbands behind are in their sixties and seventies, and the one in her forties has been married for fifteen years, and she and her husband have two kids. I want to be remembered as a wife and not an ex-girlfriend. I want to behave like a wife and not an ex-girlfriend. So I’m thinking, What would a wife do? Do you know what these wives say about leaving their husbands behind?”

  I shake my head.

  “They talk about making sure their husbands are going to be okay,” she says. “Even if I�
�m jealous of his future, I want Matt to be okay.” Julie looks at me like she just said something I’m supposed to understand, but I don’t.

  “What would make you feel that he’ll be okay?” I ask.

  She shoots me a grin. “As much as this makes me want to vomit, I want to help him find a new wife.”

  “You want to let him know it’s okay to love again,” I say. “That doesn’t sound wacky at all.” Often a dying spouse wants to give the surviving one this blessing—to say that it’s okay to hold one person in your heart and fall in love with another, that our capacity for love is big enough for both.

  “No,” Julie says, shaking her head. “I don’t want to just give him my blessing. I want to actually find him a wife. I want that gift to be part of my legacy.”

  As when Julie first suggested the Trader Joe’s idea, I feel myself recoil. This seems masochistic, a form of torture in an already torturous situation. I think about how Julie would not want to see this, could not bear this. Matt’s future new wife will have his babies. She’ll go on long hikes and climb mountains with him. She’ll cuddle up with him and laugh with him and have passionate sex with him the way Julie once did. There’s altruism and love, sure, but Julie’s also human. And so is Matt.

  “What makes you think he’ll want this gift?” I ask.

  “It’s crazy, I know,” Julie says. “But there’s a woman in my cancer group whose friend did that. She was dying, and her best friend’s husband was dying, and she didn’t want her husband or her best friend to be alone, and she knew how well they got along—they’d been good friends for decades. So her dying wish was that they would go on a date after the funeral. One date. So they did. And now they’re engaged.” Julie’s crying again. “Sorry,” she says. Almost every woman I see apologizes for her feelings, especially her tears. I remember apologizing in Wendell’s office too. Perhaps men apologize preemptively, by holding their tears back.