“Just never you mind Louisa.”
“Yeah, I wasn’t thinking about her just now. What’s the emergency number?”
“No, don’t bother them with-”
“What is it, Aunt Nora?” I made my tone as firm as I could and cursed myself for not knowing the answer already. If I was going to look after her, I needed to be ready for things like this... whatever this was.
“Nine... nine... nine,” she said between gasps.
I helped her lay down on her side on the carpet and scrambled for the phone. Seconds later I heard an almost bored voice say, “Emergency services?”
“Hi, my aunt’s in severe pain. I’m not sure what’s wrong, but she can’t even walk.”
“No x-rays,” said my aunt.
I tried to keep my attention on the emergency operator, who double checked our address. “Now, are you certain you couldn’t drive her?” he asked.
“I don’t drive over here.”
“Get a taxi?”
“Are you kidding me?”
“It’s just that we don’t like to send out ambulances if we can avoid it. They’re quite costly-”
“She’s got private insurance and is lying on the floor, unable to move. Get one out here now!”
“Right. One moment.”
It was all I could do not to bash the phone against the counter top. My aunt looked so small and her shoulders were shaking. I didn’t know if this was tears or tremors or convulsions of pain.
“One should be there shortly.”
“Thank you.”
Aunt Nora cried out again and I flew to her side. “Help’s coming,” I said. “Just try to relax.” I cast about for something, anything to make her more comfortable and seized upon the throw pillows on the couch. I packed one underneath her back and tucked the other under her head.
“I just don’t want x-rays,” she whispered. “Or scans or-”
“Listen to me. First we’re going to get you to an emergency room, and then we’re going to talk to a doctor, and we’re going to do whatever needs-”
She cried out again and tears ran from her eyes. One splashed off the tip of her nose and the other drew a line of mascara across her temple. I hadn’t noticed that she’d put on makeup that morning. I moved to wring my hands and noticed that I still held the phone. For one hazy moment I wondered if I’d hung up or if the operator were still on the line, but the sound of the doorbell startled me into tossing it onto the couch and dashing out into the entry way.
The paramedics, two men built like linebackers with a rolling stretcher between them, followed my lead. At the sight of Nora, on the floor, they both knelt down. “Hello?” said one. “Can you hear us?”
My aunt nodded, but didn’t open her eyes.
“Where do you hurt? Your belly there?”
Another nod.
“Can we feel?” He moved to straighten her legs away from her torso, but she screeched so loud that I clapped my hands over my ears.
“Right, I can’t tell if the abdomen’s distended-”
“Yeah, we just need to load her up.”
The collapsed the stretcher so that it was low enough for them to hoist my aunt onto it without much effort. They raised it up again and I followed them as they rolled it down the hall.
“She’s got private insurance,” I babbled. “That affect which hospital she goes to?”
“Not when she’s like this,” said one. “We’ll take her to the closest.”
“Right,” said the other one. “You want to ride in the ambulance, or you going to make your own way there?”
“I’ll come with you if that’s okay?” I was at my wits end, but I did remember to close and lock the door.
The emergency room throbbed with noise and activity. Sounds ricocheted off the cheap industrial tile floor and plain white walls. The paramedics wheeled the stretcher in through two sets of sliding glass doors, exchanged a quick series of rapidly fired words with a clipboard wielding woman in scrubs and then carried on into the fray. Doctors and nurses bustled back and forth, yanking on clean rubber gloves with their teeth. Somewhere in the background, an alarm pinged and voices began to shout. The place reeked of antiseptic cleaner.
The paramedics deposited my aunt on a cot, drew the curtain shut around it, and were gone. I paced in that little curtained space, wondering if I’d need to fill out insurance paperwork or answer health history questions or what. Aunt Nora looked ashen, as if all the blood had leeched out of her face, leaving only thin, papery skin behind. She looked much older than forty-five, and I was terrified. I had no idea what was wrong, only that it was something bad. I felt at a loss, even though I’d spent hundreds of hours in hospitals, looking after my terminally ill mother and sisters.
“Eliza,” my aunt whispered, “please don’t let them take x-rays.”
I had no idea how to respond. I felt like I was drowning, like all the noise and bustle on the other side of the curtain were tangible, palpable, able to displace the air in the room until I blacked out.
Get a grip, I thought.
“Eliza?” My aunt’s thready voice was plaintive.
“Just give me a sec,” I told her. I stepped through the curtain and into the insanity beyond. I had to leap back to get out of the way of a nurse pushing a man in a wheelchair who moaned about chest pains. Another team of personnel in scrubs dashed past in the other direction, talking what sounded like a code of letters and numbers.
My cellphone was warm from my pocket. I pressed it to one ear and covered the other with my hand.
“Hello?” Colin’s voice answered after the third ring.
“Hi. It’s Eliza.” I tried to keep my voice steady, but I knew I probably sounded hysterical.
“You sound like you’re calling from a warzone.”
“I’m in the emergency room.”
“So you are calling from a warzone.”
“Look, I am so sorry. You were probably asleep. I mean, I know you work nights, and it’s totally inappropriate for me to call you for help while you’re not at work, but I just... I just...”
“Breathe,” he said. “Deep breath. It’s all right. You can call me. What’s happened?”
“My aunt’s in such severe pain that she can’t even stand up, but she doesn’t want x-rays.”
“What do they want to x-ray?”
“Well, nothing yet. I don’t know. She’s just afraid-”
“Okay, slow down. Back up. Where does she hurt?”
“Her stomach.”
“Like her belly area?”
“Yeah.”
“That’s soft tissue. You don’t use x-rays for that. She’ll need an MRI-”
“Which she’ll hate too.”
“Riiiight, or they can do an ultrasound. Ultrasound might be quicker.”
Ultrasound? “Really?” No one had ever used an ultrasound on my mother or sisters, that I’d seen. For no logical reason, this made it seem like a much more humane and civilized tool. I’d always associated it with pregnancy and new babies and all that happiness.
“Yeah, but it’s up to the doctors there, you know. They’ll need to do a full examination and you’re probably in quite a long queue. Anyone given her a pain pill?”
“No.”
“Well grab the nearest nurse and ask her for a paracetamol or something. The doctor will want to prod her belly a little, and then they’ll decide what kind of diagnostic equipment to use. It won’t be x-rays, though.”
“Thank you so much.”
“It’s no worries. You all right?”
“I’m just worried.”
“Right, of course. Look, I’ll call you tonight. If she’s back in hospital, I’ll make sure to ring and check on her.”
“Okay. Thanks.” Gray spots spun in my vision. I made myself breathe deeper and more slowly as I put my phone away. The antiseptic smells and the sounds of medical devices beeping were more than I could take. I hated hospitals.
You aren’t the one who’s sick
, I reminded myself. This wasn’t about me, and I’d left my aunt alone in her little curtained cubicle. “Excuse me.” I stopped the next person in scrubs who went by, a young woman who gave me a startled look. “Sorry,” I said. “My aunt is in extreme pain. Can she have a paracetamol?”
“What’s she in for, then?”
“We don’t know-”
“Can’t give her drugs until we know.”
“You’re kidding, right? She can barely move.”
“Right, look, I’ll see what I can do,” the woman said in that tone of voice that let me know she was going to forget all about me in thirty seconds, and she just wanted me to leave her alone.
“Well who can give me some pain reliever?” I demanded. “Something mild. I’m not asking for morphine. Ibuprofin will work.”
The woman shook her head, so I jerked open the curtains. My aunt hadn’t stirred. Her jaw was set and her forehead had permanent wrinkles as she withstood the agony. “Fine,” I said. “Then you tell her you can’t give her pain reliever.” Being nice was a waste of time in a hospital. I’d learned that as a child. Healthcare workers looked after squeaky wheels first, to make the rest of their job more bearable. I folded my arms across my chest in a way that I hoped made it clear that I would not let this woman go if she didn’t do something to help us.
She shut her eyes a moment as if willing me to disappear, then said, “All right, what’s wrong here then?”
“Severe pain. That’s all I know.”
“She broke her arm there?”
“Yeah, a week ago. Got lightheaded and fell. This pain is in her stomach.”
The woman picked up my aunt’s chart and flipped through it. “Right. Let me feel your stomach.”
Though I moved to protest, she arranged my aunt deftly so that she could prod her stomach with both hands. “Right, okay, no intestinal blockage. No ruptured appendix. This hurt?” She pressed hard and then let go fast.
My aunt didn’t wince any more than she was already wincing.
“Right, we’re going to need an MRI.”
“What about an ultrasound?” I said.
“Or an ultrasound.”
“Would that be... faster?”
“Could be. Right. I’ll be right back.”
I folded my arms and she gave me a longsuffering look. At least we understood each other. I was one of those kinds of relatives, the ones who took no prisoners when it came to getting healthcare for our loved ones. I didn’t take my eyes off her until she’d rounded a corner and I had to jump back for another team of paramedics wheeling a stretcher.
“Honey, I don’t want a scan,” said Aunt Nora. Her voice was so soft, it was hard to hear over the hubbub.
“Ultrasound,” I told her. “Fast and easy.”
“Even that.”
“They have to figure out what’s wrong. Don’t you want to know what’s wrong?”
The woman who’d helped us before came back around the corner with a man in scrubs who pushed an ultrasound machine on a cart. They maneuvered over to Aunt Nora’s cot and yanked the curtains shut behind them, closing the four of us in.
“I need to do a full pelvic exam,” she said to me. “You might want to wait outside-”
“No,” said my aunt.
“I’ll just avert my eyes,” I said. I turned to look at the wall.
“Right, need you to lay on your back,” I heard her say.
If this hurt Nora, she at least didn’t cry out.
“Okay... right... I’m feeling one ovary, but not the other. Have you ever had an ovary removed? I see you’ve got an incision scar here.”
“No,” said my aunt.
The realization hit like a slap in the face. A missing ovary meant the next thing to look for was a tumor, one that might have ruptured the organ. That event, I happened to know, was extremely painful. It had happened to my sister. I also knew that cancer of the ovaries could sneak up on a person. Its lack of early symptoms made it deadly.
“You know what this is, don’t you?” I said. “That’s why you don’t want an ultrasound.”
“Sweetie...”
I leaned one arm against the wall and pressed my forehead to it. This could not be happening. Aunt Nora was like me, one of the lucky ones, a survivor. But even if she’d been spared the family curse, that didn’t mean she was immune to cancer. It attacked people without the BRCA mutation all the time. Moreover, I’d never asked her about the gene mutation. For all I knew, she might have it after all.
“Okay, this gel will feel cold,” the woman said.
“Did you have any symptoms? Any at all?” I asked Nora.
“I’m seeing only one ovary... okay, right, we’re going to need to book you in with an oncologist. This will probably need surgery.”
“No...” My aunt’s voice sounded weak and wrung out.
“She’s got private insurance,” I said. “Can you transfer us to St. John’s?”
“Right. Let me just ring them and see. But first let’s get your clothes back on.”
I waited until they’d done that before I turned around to look at her.
Aunt Nora’s eyes were still squeezed shut. Her pain hadn’t been treated or dealt with, though I noticed the woman in scrubs was flicking the needle of a syringe full of something. “You’ll feel a sharp scratch,” she warned my aunt before she slid the needle into the flesh of her arm.
“It’ll be okay,” I said. “I’ve been down this road before. I’ll take care of you.”
“You’ve been through this too many times already,” she whispered.
“There is no ‘too many’ for the people I love. I’ll go through this again with you, no question. We are in this together.” Her eyes were still shut, so she didn’t see me lean against the wall and let the sounds and smells and lifedraining light of the ER wash over me.
“I can’t believe this is happening again,” I said to Colin that night as we stood out in the hallway. Aunt Nora was now at St. John’s.
“You don’t know that it’s cancer.”
“Sure, it might be a totally benign tumor that just busted her ovary. Come on, you don’t believe that.”
“I’m just saying, don’t jump to conclusions. Just because that’s how things played out last time someone in your family had this-”
“The last three times.”
His eyes widened at that, as if he wasn’t sure he’d heard me right. “Three times?”
“My family has the BRCA mutation, you heard of it?”
“Oh, right, yes.”
“Even for a family with the mutation, our health history is bad. I think the woman who asked me all about it tonight thought I was lying.”
“How bad?”
“Both my sisters, my mother, her sister, my grandmother and her two sisters-”
“Are you serious?”
“All diagnosed with cancer in their twenties, all dead before the age of forty. Three of them got cancer in the ovaries at some point.”
“Seriously?”
“Yeah.”
“So, if you don’t mind my asking, have you ever been treated for cancer?”
“I don’t have the mutation, and I didn’t think my aunt had it either.”
Those liquid brown eyes scanned my face for a moment as he let that sink in. “You must have seen a lot of hospitals.”
“You have no idea.”
“Well, anyhow, we’ve booked her for an MRI first thing tomorrow and we’ll move quickly. I’ll make sure everyone who needs to know, knows about how fast cancers tend to spread in your family.”
“Thank you.”
I went into my aunt’s room and found her staring listlessly at the wall as if it were some dark, infinite, abyss. Her hand, when I took it in mine, was cool. “How are you?”
“Honey, I don’t want surgery.”
“MRI first.”
Her mouth tensed slightly as if she had to fight the urge to say no.
“You can’t just give up,” I said. “
You’re a fighter. You’re a survivor. You’re like me.”
That made her gaze flick back to my face. “I’m not as tough as you.”
“Are you kidding? You’re the strongest woman I know. I admire you. We’re going to fight this, and we’re going to win.”
My aunt’s eyes unfocused. It was as if I could feel her slipping away, out of her body into a nether space where I couldn’t reach her.
“Please don’t give up,” I said.
Her hand in mine was too relaxed. Limp, almost.
“I’ll paint you anything you want. Please.”
The light returned to her eyes and she chuckled. “You’ve got my number, don’t you?”
“It’s all I know how to do. I mean, I know this has to be hard without Paul, and if I could bring him back for you, I would. But I can’t. I can capture moments, though. Is there anything else you want immortalized and that you don’t have a picture of? Some scene from your time with him that is vivid in your mind, but that no one else ever saw?”
“Oh, there are hundreds of those. Millions, even.”
“Let’s find one. And if you want to tell me long stories until we do, that’s fine by me. I can listen.”
Her hand tightened around mine. “I don’t know what I’d do without you.”
“I’ll stay as long as you need me. My visa’s good for six months, and then I can just take a trip over to Ireland or France and come back in for another six.”
“You’re sure this is okay? I don’t want you to stop living your life for me.”
“I do not miss my life back in Portland. No, this is good. Really.”
Those stormy gray eyes scanned my face again and her lips parted, as if she would say something, but no words came.
I waited and gave her the space she needed to collect her thoughts.
But she gave my hand a squeeze and turned away. “I’m just so tired.”
“Okay, well, I need to leave soon anyway, but I’ll be back tomorrow.”
When I arrived back at Nora’s house, there was a tuna casserole on the front stoop. “Ah, there you are,” said a voice behind me.
I turned slowly. Louisa was not whom I wanted to see at the moment, but there she was, striding up the driveway. I wondered if she’d been staked out across the street. “What’s happening, then?” she asked. “Is Nora back in hospital?”
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