The Miracle (part 2): a woman’s story in 2 parts

“Emily.” It was the doctor’s voice, and he was leading her into a seat in his office as if she were an old lady. “Emily, it’s good to see you again…” his voice trailed off as he inspected her. “But you were supposed to have come back to see me a month or so ago, remember?”

Why was everybody always asking her if she remembered something or other? She was here wasn’t she? And besides, he knew she couldn’t keep running back to him with every little complaint until she was sure.

“Now remember last time you were in, you said you were having some…ah…” He referred to a folder that lay open on his desk. Couldn’t he remember, she wondered? It hadn’t been that long ago. “You were having some trouble with your bowels,” he continued as if he hadn’t really forgotten. “Constipated, bloated, vague discomfort in your pelvis…”

‘Vague discomfort’? Had she really said that? She became aware that he was drumming his fingers on the desk. It was all very funny, really. He was obviously expecting her to say something but all he would do was look at her quizzically over the bridge of his glasses. His straight, mouse-brown hair was too long for his thin body, she thought. And he was wearing the same creased grey suit as last time. What kind of a doctor only owned one suit?

Finally he ventured to speak again. “What’s been happening lately?” But she only smiled. “Bill told me you’ve been quite sick…” Again the look, and again she refused to be manipulated. “He said you’ve had some more pain and have started to vomit.”

She shrugged. Damn that Bill! This was all supposed to be so different. Why did Bill care anyway? He was never around much and even when he was, he was merely there. But so was she -trees in a meadow: untouching, indifferent, one or the other always in the shade.

Doctor Brock looked annoyed and was having trouble disguising it. “Bill said you wanted to see me Emily.”

She stared at the open file in front of him filled with writing in blues and blacks. Why would he use different colours, she wondered? And some things looked as if they had been underlined; this puzzled her as well. She didn’t think she’d ever told him enough to underline. She blinked, trying to resolve whether or not the line went through or under a sentence. Even doctors made mistakes. The chart was too far away to see clearly, however, so she leaned forward slightly, and as she did he cleared his throat.

“What did you want to see me about Emily? You’re still feeling unwell, aren’t you?”

There he goes again, she thought -just like Bill: he hadn’t asked, he’d stated -accused, actually. As if feeling unwell was wrong -no… expected. She was amazed at the stupidity of the man. How could she confide in someone who couldn’t understand how she felt about it all? She should have gone to a woman.

He sat back in his comfortable leather chair, determined to wait her out. Why was he so stupid? No, obtuse; she knew he wasn’t stupid exactly, just unable to relate to a woman’s needs at a time like this. She stared at him, confronting him silently with her unblinking accusation. She needed someone else; she was sure of it.

He coughed at her quiet threat, as if the noise might dissipate it -make her blink first, maybe. But she was determined. “I’m sorry doctor, you just don’t seem to understand.”

The sudden flurry of words made him jerk forward awkwardly in his chair. She got up to leave. “But you haven’t even told me what’s wrong, Emily. How can you expect..?” She was through the door before he could finish.

“It’s a woman doctor I need,” she told Bill in the car. He may have heard, but he didn’t turn his head or even shrug; it didn’t really matter anymore.

*

Dr. Heath was very young -something the Yellow Pages didn’t mention. But at least her door had the usual trappings of confidence: a sedate, cream-on-plastic plate with the requisite number of letters after her name -a few extra, even, as if to invite entry.

As soon as she got inside, though, Emily realized she had made a mistake. It was cheery enough, with heavily carpeted floors and a large double-glazed window with a view of the city; the plants were nice, if a trifle under-watered; and there were pictures on the walls of babies: babies with hats, babies in diapers, babies at breasts… It wasn’t the office that bothered her. It was the age of the patients that seemed strewn about like clothes: teenagers -all of them. Some pregnant, some with skirts up around their waists -a rogue’s gallery of young people, all staring impudently at her as she crossed self-consciously in front of them to the front desk.

The receptionist couldn’t have been much older, and as Emily gave her name she thought she caught a fleeting smirk that never quite surfaced. “You’ll have to fill in this form for the doctor, Emily. And I’m afraid she’s running a bit late today.” It wasn’t an apology, simply a statement. Take it or leave it.

The form was simple enough: allergies, major illnesses, medications and the like. Nothing too personal -she liked that. The doctor, however, was.

Dr. Heath was a pleasant little thing of about twenty-five, blond, smartly dressed and with eyes that seemed to hunt like spotlights when they hit. She fastened them on Emily. “My nurse mentioned something about you being late for your period, Emily,” she said noncommittally.

Late? That was a laugh. But Emily nodded. “It’s been four or five months now.”

The doctor didn’t seem surprised -or at least her eyes were calm. “Were they regular before?”

Emily closed her eyes impatiently. Of course they were regular. What was she getting at? She took a deep breath. “Yes.” And then she opened her eyes and stared out the window.

“I see,” said the doctor. But Emily didn’t believe her. Her eyes were too steady to be real; nobody was that calm. Dr.Heath wrote something in the chart then looked up again. “Any other symptoms?” She actually smiled when she said that, but Emily was not taken in.

“Maybe you should just examine me, doctor.” It was a simple statement, made calmly, quietly, but the doctor’s expression immediately changed.

“I’m afraid I’ll need to know a few more things about you before we get to that.”

“I’ve filled in the form, so it should all be in there, doctor,” she said confidently. You had to get control of these things early.

Dr. Heath stared at her intensely for a moment, obviously deciding what to do, then shrugged and pointed to a narrow door that Emily had not noticed when she entered. The doctor looked smaller now -pale even. “You’ll find a gown on the table in there. Please undress from the waist down. I’ll be there in a moment.”

It was long moment and Emily could hear voices through the door, but not clearly enough to understand. The doctor’s though, sounded excited, agitated. Had she made the doctor uncomfortable? Emily thought about it for a moment and then rejected the notion: she’d been civil. They were both adults.

The examining room was cold but she stripped to her underwear and sat on the examining table huddled under the flimsy gown. Soon it would be over. Should she tell Bill? He would eventually find out, she realized, but could she count on his support? She chuckled at the thought.

Dr. Heath suddenly appeared at the door, smiled wanly, and asked her to  lie back. “Where does it hurt, Emily?” she said softly.

Emily lifted her head. “Hurt? Who said it hurt?”

The doctor straightened her shoulders a little. “I’ve talked to Dr. Brock.”

“You had no right…” she started, tears forming in her eyes. “What I told him was… just between us.” But she realized how silly that sounded and looked down at her feet.

“Emily, Dr. Brock was concerned. I’m concerned.”

“You had no right,” she repeated, fighting back a sob. “I suppose my husband talked to you as well…” The doctor nodded. “You’re all trying to make it all so… so abnormal,” she said grabbing for her clothes. “Can’t any of you accept it for what it is?” Her cheeks were wet now.

Dr. Heath didn’t move. “What is it Emily?” she said in a soft, sad voice. Emily glared at her and finished dressing. “What is it?” she repeated and grasped her shoulders.

Emily broke free and forced her way past the doctor. “A miracle,” she said between sobs.

“Emily!” There was no mistaking the tone this time. “Emily I’ve talked with your doctor…”

She was through the door but she stopped by the window, near the doctor’s cluttered desk. The cars had their lights on now and it was raining; the sky barely cleared the tops of the buildings. Why was it always like that, she wondered.

“Emily, please listen to me…”

But she just shook her head. Tears rolled gently down her cheeks and she made no effort to wipe them away. Why should she listen? She was living with the proof right here in her abdomen. Her hand reached involuntarily for the palpable swelling growing quietly inside. There. It moved again; she was certain it did. Nothing they could say or do would convince her otherwise. Perhaps another doctor… Yes, that was it, another doctor -an older, more experienced one this time.

The Miracle (part 1): A woman’s story in 2 parts

It was still there, no doubt about it. She patted her stomach warily, as if she were afraid it would go away with too critical an examination. But it was real -or as real as any present could be inside a box- hidden away, untouchable: Schrödinger’s cat…  Some things required faith; not everything in life was a punishment.

Up till now it had been a draw. Meaning, purpose, goal -whatever one called it- was a childhood memory, or maybe a fantasy. The fabric of her life, like an often-mended blouse, was intact but barely recognizeable. Even Bill, who had promised so much at first, had not so much the power of a colored thread in any dream she wove. Nothing distinguished him from a thousand others. He was like a picture that had hung above the bed for years: describable in an instant, but noticed only when missing. He added nothing to her life, subtracted nothing. Were other men the same, she wondered, looking vacantly around the room?

She was sitting in the front room – the back room, actually, since it looked out over an ill-kept back yard of aging trees and spotty grass. It was raining as usual and the rotting boards of the patio seemed to stare blankly at the clouds like old men waiting in their beds to die. The furniture was the same, she thought, itemizing it one by one as if she were still a stock clerk after all these years. A china cabinet made of some cheap wood by her grandfather a century or so before, stood at fragile attention across the room, arthritic and brittle with age. She ticked it off mentally with a sigh, noticing the lack of dishes on its shelves. Like her, it merely occupied space.

A lot of the furniture was like that, though -the couch on which she sat, for example. Even looking at it, she was hard-pressed to name the colour. Its utter banality saved her from the need to classify it as to style or pattern. It merely was; it existed, and was allowed to, simply because it was there. No other reason. Nor did the coffee table distinguish itself, except that it was not the floor, nor was it the same color or texture as the blue-green rug. The room was an occupied space; it was not the kitchen, it was not the bedroom… The room and what it contained -including herself- could best be characterized by what they were not; some inscrutable pique of nature had defined them all by inference only.

Maybe that’s why her life had never changed: Nothing is difficult to rearrange. Until now, that is. She allowed herself a little smile and glanced at her unseen present, her secret. For a moment in her mind, it seemed to glow, the colors expanding and wavering with her breath. What did they call those color-filled boxes you held up to the light and turned? Kaleidoscopes? In the grey, unpolished world she now had a kaleidoscope of her very own.

A brief pain lanced though her lower back, followed by a burning sensation in her groin. Not yet, she thought, clenching her fists tightly against the jolt. But this wasn’t the first time she’d felt its complaint. There was also the pressure -the constant, dragging pressure that made her feel as if all her pelvic organs were going to drop out- and the bloating, to the point of nausea. All to be expected however, and she smiled again, embarrassed by her sudden wealth.

It had been a couple of months since she’d begun to feel different. At first, only the pressure and discomfort after eating -nothing major, and really only noticed because she had nothing else to notice in her life. Well, that wasn’t quite true: Bill had seemed more attentive to her. He said she was losing weight, not eating -that she was changing on him. Bill didn’t like people to change because then he never knew what to expect. But what did it matter what he thought? She could see where she was gaining weight… She was different, and that was that.

Bill seldom confronted her with the change, but she could tell he was concerned. Communication was not something he entered lightly and he often changed his mind on the brink of a sentence. Recently he had been trying to fathom the problem from a distance with inquisitive glances and a puzzled look on his face -attempts, in other words, to make her admit there was something wrong. Admit? What he really wanted was a confession. As if she had done something wrong by not being the routine, predictable Emily. She shrugged and sighed inwardly. Maybe if he just talked about it… Or about something: the weather, the supper, her hair, the time of day -anything. Maybe then it would be alright… Or a least better… But of course in a grey and toneless world, words are just passing clouds, indistinguishable after a while from everything else.

She was interrupted in her reverie by Bill -not the man (he seldom came into this room), but the voice… the command, rather. Ever since she had known him, even his questions had been commands garnished over. Then, at least he had tried to disguise them; now he seldom bothered.

“Emily, what are you doing? You’ll be late for the doctor.”

“In a minute, Bill.” Oh how she hated him sometimes. Hated? Was that true, or was it just painful when he surfaced abruptly from the background where he lived? Possibly where they both lived. Until recently she couldn’t have said where she lived, but of course all that was different now.

She rose slowly to her feet, dizziness stirring the room like pudding -but it didn’t last: things like that are not designed to last. Markers -that’s what she called them- events that rimmed a change of state: up, down, standing or sitting… She did not dwell on the thought, and the dizziness passed as quietly as it had arrived.

She ventured a few tentative steps across the carpet but towards the window and not the door as she had intended. A movement outside had caught her eye and she was captured by the damp, leaf-strewn lawn. A four o’clock wind was mindlessly poking at the balding trees that stood like a living fence around the yard. They, too, were brown, but not what had attracted her. There was also the patio, rambling and broken, where a chair leg had teased the ancient boards apart. It was brown as well. And so was the grass under the rhododendron bush that squatted like a disheveled toad in the middle of the yard, untidy, unadorned… But it was the lawn’s problem, not hers.

She sighed and looked away. But not soon enough; there, almost hidden under a yellowed leaf beside the railing of the decaying deck, she saw it. Only the tail was visible now, but a smeared, red line marked its erratic trail. While she watched, the tail twitched once. A cat, brick-still on the rail above, studied the movement for a moment, then pounced. Emily quickly shut her eyes as a wave of nausea rolled over her.

“Emily! What’s keeping you, woman?” This time it was the man who entered the room. Balding and short, he kept fingering a caterpillar-like moustache on his marshmallow face. He looked out of place in the room -like some waxen, glistening beetle that hadn’t yet scuttled out of sight. His head was perspiring and the dim light from the yard speckled it with tiny shadows. “Emily, I thought I asked you to hurry up!”

She looked at him -or rather, through him- like she had the window. “What? Oh, the doctor… I’d forgotten,” she lied.

He stared at her with unreadable insect eyes. “Forgotten?” he hissed, “You asked me to make the damned appointment in the first place. Christ woman..!” He stomped his foot in anger, but to her the gesture and the words were empty. “I can’t understand you,” he sputtered, choking on his saliva. “For a month you’re sick, and when you finally decide to do something about it besides complain, you forget.”

“I’ve never complained,” she interrupted softly.

His face grew red, and he paused long enough from fingering his moustache to wipe his forehead with his sleeve. It was a sloppy habit, she thought, and blinked twice.

“No, you never complain!” he continued. “Not you. Not in words, anyway; words I could handle. No it’s all the other things: the sighs, the groaning at night… No, you don’t complain, you torment.”

It was meant to be cruel she realized, but it had no effect. The words just disappeared into the cracks of the floor hitting nothing: water sucked down a drain.

He turned abruptly and left the room. “I’ll be in the car,” he shouted at the hallway, then vanished as if he’d never been. She could hear him fussing around by the front door, banging things or dropping them in frustration, but he might as well have been outside for all it mattered to her.

The tail was gone now, she noticed; so was the cat. She shuddered at the hidden, unfair struggle going on somewhere outside, but even as she did, it occurred to her that it probably wasn’t like that at all. Life and death likely snuck past her each day unseen… Like her life.

A sudden spasm of pain shot through her pelvis leaving her nauseated. And a horn somewhere continued its insistent complaint. She smiled as the pain eased slowly from her back. Unseen could be a wonderful thing: it was a gift not yet unwrapped.

On Remembering Faces

Faces are important; they are like little signs we wear to allow others to recognize us. Unlike, say, fish they are distinctive and carry verbal labels further enabling meaningful categorization. A face without a name begs inquiry; a name without a face, recollection or even retrospection…

In a way, remembering faces is a sign of respect: you have had dealings with them; they had temporal significance for you; they were and remain important. And in standing out from the crowd –egregious in its original sense of standing out from the herd- there is a bond, however tenuous. I passed a smile in a hospital corridor the other day and I mistook it for agape: that look we donate to total strangers that we pass like ships. And I saw the look of disappointment and saw her whisper something to her partner who glanced at me as well. She stopped and turned a few steps past me and addressed me by name. And even when she explained that I’d operated on her mother a few years ago, my recollection of the event remained wrapped in cloud. Overcast.

Some people have the eidetic skill of instant recognition and with that identification the story of the paths they shared, along with the appropriate assignation of adventures encountered along the way. It immediately sets both parties at ease; there is no awkward pause, no need for hasty explanations of how each was once significant to the other.

But recognition is a blessing not equally bestowed. There are times for many of us when a chance encounter contains as much information as leaves on a tree, and an individual is as anonymous as a fallen twig. I cast no aspersions, but memory has a way of defocussing details, melding them into a delicious stew of once-tasted dinners. Or am I making the mistake of assuming I am representative of the average other? A mental excuse: an inadvertent equivalent of psychological projection?

I have been in medical practice for many years now; I have encountered myriad people along the way, delivered uncounted thousands of babies -maybe I do have an excuse… And yet to forget a face that greets me on the street -a face with which I have had a nine month relationship, perhaps- still seems rude. Insensitive. The fact that it may have been ten years ago -or more- has not dimmed their memory of the relationship and its consequences. The child at their side refusing eye contact with me is an integral part of their life -one they shared with me long ago. They live the memory; I claw desperately at the door of a cupboard where I have stored the files.

Some faces I remember, of course: some people have a way of welding their identity onto the shelf -forever distinct, immutably present and on display. They are the caffeine of memory, but like dessert, uncommon at most meals.

Now I have to admit that most people are interesting, and all are distinctive -or seem so- at the time. Even the most obnoxious patient sows her seeds; recollection depends not so much on the quantity as the quality of the experience. And it may not be a two-way street. We all walk at different speeds, and touch with different skin. We may hold our expectations in common -there are some universals that seem self-evident- but our perceptions are uniquely our own. We, alone, wear them, feel them, live them… They are why we take home different messages -patient and doctor. They are what individuate us. Separate us…

But I would still love to return the unsolicited smile of remembrance with a look of wide-eyed honesty.  I need a book somewhere inside with a specially marked page that I could read and interpret quickly enough to make it seem that her face was never stored in the bottom of some pile; that she, at least, was special. Unforgettable.

But my guilt shines through each time I pass; I hope they understand I don’t mean to forget. But oh, it presses to my memory, Like damnèd guilty deeds to sinners’ minds –Shakespeare understood, I think… Even if I’ve forgotten the context.

The Awe of BRCA

Awe: the word has been pasteurized, connotized almost beyond recognition. But I suppose that’s what happens to all really powerful words. There’s a life-span to language; a generation if you’re lucky; a year if social media gets hold of it –likes it… But I think the ship of awe and all of its elegance went down quickly -even before Facebook or Twitter could sink it. It’s a shame because I am sometimes filled with it.

Different things inspire it in me; there’s no formula, no recipe for the appeal. I am sometimes simply stopped in my tracks, occasionally accorded an audience with grandeur. Majesty. Awe: the ineffable sublimated and instilled wordlessly into my head.

Most recently it was occasioned by genetics -unsurpisingly, because I understand so little of it nowadays. Since the genetic code was cracked and genes in all their undress were unfurled from where they ruled unseen in their closet, I have been a stranger in an even stranger land. I sometimes feel as a child must, confronted with an explanation that has not lost any of its initial magic. Any of its mystery…

And it’s not merely the unravelling of the genetic puzzle that intrigues me. I am scarcely moved by the knowledge -no, not the knowledge, the words- that on the short arm of chromosome 3, position 21 (have I got that right?), there exists a gene that makes a chemokine (a what?) that has an important role in the resistance to infection. I suppose I should care more, but I don’t.

The gene that has captured my interest is the BRCA gene. ‘BRCA proteins are required for maintenance of chromosomal stability in mammalian cells and function in the biological response to DNA damage’ -that from the Journal of Cell Science. In other words, they make sure that the DNA is okay, and deal with it if it is not… They repair damage and keep the cell growing normally. They suppress tumours; mutate the genes -cripple them- and the oversight is lost.

That much I knew, but what intrigued me was that the BRCA genes also occur in plants. They evolved about 1.5 billion years ago in whatever single-celled creature that was the common evolutionary ancestor to both animals and plants. The fact that these genes also exist in plants (most studied in a small flowering plant called arabidopsis, because in 1990 it was chosen by the National Science Foundation as the first plant that would have its genome sequenced) suggests they have an important and enduring function throughout the phyla and kingdoms. Plants, too, need to manage what happens to their DNA: they are rooted to a spot and can’t avoid recurring environmental stress factors that might damage it. As an example, some mutations in the arabidopsis BRCA allow certain cells to divide uncontrollably making the plant very sensitive to various forms of radiation. Sound familiar..?

Not all of the BRCA gene is the same in different organisms, of course: different domains, or portions, with different functions are preserved that seem to have an evolutionary importance relevent to each entity. Why re-invent the wheel? Nature fiddles with what it already has -what it knows. That mutations in this same gene should have such important effects on breasts and ovaries in humans is interesting, to say the least. All organs have DNA that is responsible for their growth and development; all DNA needs surveillance and repair; all organs have a cancer potential…  So was there a common ancestor somewhere whose BRCAs first assumed uber guardianship of breasts? Whose unintended mutations engendered these hereditary risks -a family, an individual..? Presumably stuff has to start somewhere.

And although arabidopsis doesn’t have analogous organs to humans, similar BRCA mutations do not seem to be as lethal, so I suspect that studying them may lead to some important insights. Maybe they already have: I can barely understand the way the studies are worded and find myself perusing only the Introduction and then skipping past the Results section to Conclusions where the authors discuss whatever ramifications they feel obtain from the experiment. I still read through a glass, darkly.

But somehow, the knowledge that we are in a sense all part of the same organism is epiphanous. Humbling… As Shakespeare (in Troilus and Cressida) has Ulysses say: “One touch of nature makes the whole world kin.”