by Kat Chow
They tell us that, ‘Oh, it is the cyst—it was ten pounds—and benign and you’re all good.’ So we were happy. So we trust them. The doctor recommended that my mother return for cancer screenings, but she failed to follow through. I know that my mother, like all of us, was skilled at hearing only what she wanted. It seems likely that her doctor’s suggestion for more tests might have sounded like a breezy afterthought. I can understand this. I often tell myself, I am young, my body is strong, and I delay making appointment after appointment, physical after physical, until I think about my mother, and I schedule something for the next week.
* * *
I can’t find documentation of how much my mother’s insurance co-pays cost or what her deductibles were. But I see from the admission sheet to NewYork-Presbyterian Hospital that her primary insurance was “Aetna HMO,” and her secondary insurance was “Self-Pay.” HMOs are generally for people who don’t think they’ll get very sick; it’s usually for young people, which makes the fact that my mother had this all the more gut-wrenching. In order to see a specialist covered by an HMO, one first must get a referral from their primary care physician. Even then, it is not uncommon for the patient to incur hefty bills that must be paid out of pocket.
Actually, my father says, bringing up the summer before my mother died, the family doctor we go to when your mommy’s stomach was all bloated, he told us it was a stomachache.
At my parents’ urging, the doctor referred them to specialists.
It took so long to get an appointment, my father says, and when they finally did, they say, ‘Oh, it’s just indigestion or bloating’ and they prescribe her some medicines.
But as my mother’s aches persisted and her stomach continued to swell, she returned to our family doctor. This time, she was seen by a different physician at the practice—his wife.
When the wife looked at it, my father says, she saw symptoms of ascites, which is when fluid builds up in the abdomen usually due to problems with the liver. She told Mommy to go to the emergency room immediately.
This doctor, my father says, had more experience with the “female body” and “female symptoms.”
Why can’t a female body just be a body, I want to ask my father. But I’ve never heard this story before, so instead I ask: But what do you mean, ‘because of the female body’? This might be the closest my father will come to talking about sexism. Do you mean that Mommy’s first doctor just thought Mommy was complaining for no reason and it wasn’t a big deal?
Maybe, my father says. Could be. Probably.
OK, I say. I sink further into the couch and wait for him to say more.
OK, I say again, after a few minutes. OK.
* * *
Lai Yi Ma once told me that before Kau Fu’s wedding, his future in-laws tried to dissuade their daughter from marrying into our family. It seemed all the Yu women tended to die young, they said. Uterine cancer killed my grandmother at forty-one, and other women in the family had medical histories that were so distinctly female—again, this word, which seems so outdated now—resulting in hysterectomies or infertility. These future in-laws didn’t want this for their future grandchildren. My gung gung assured them that all of these deaths and illnesses were flukes.
It’ll be OK, he must have said. But would it? Has it been OK? This worry was itself a curse, like saying the superstition out loud made it true.
* * *
Mommy, everybody has their theory about your death. Your brother and husband still seem to think this was preventable, if only others had acted differently. But I want to hear from you. Why was it that you avoided going to the doctor all of those years? I know that these are not answerable questions—that there is likely not just one answer—but still I want to ask: Was this a problem of money? Or dread? Had you sensed, with trepidation, something shift within your body?
Did you fume when that doctor said the pain tearing through your stomach was only just irritable bowel syndrome? Did you ever wonder if this was linked to your earlier surgeries?
Did you say, knowing your own self, but still qualifying and deferential: No, I don’t think that’s right.
14.
If we had known that your illness was killing you in the months and years before your actual death, would that have helped you live? I’m stuck on that. I keep going back to whether knowing could have stopped the freight train that was your cancer.
I steel myself while I type into Google: How much does a human heart weigh?
The first result says a human heart weighs about eleven ounces, or 310 grams, and that it is about the size of a fist. That is small and dense. For context: 310 grams is about the equivalent of two average-sized navel oranges.
When my sisters and I were children, our father peeled an orange at the kitchen table after dinner most nights. He was careful as he sliced an X into its skin with a butter knife, tugging it off the fruit so it looked like a flower. He handed us each a couple of pieces, which lay like fish in our palms. I tore the pith from mine and squeezed my hand around them before sucking the juice, one by one.
Afterward, my father set the peels to dry on the kitchen counter to put them in a soup, though he could never use enough. Years after you died, we still had plastic containers filled with those skins, all of them shriveled.
I Google how much a carton of cigarettes weighs because I imagine you clutching one in your hands every night, your fingers sweaty. On Yahoo Answers, somebody asked this exact question, and one person replied that a pack weighs seven to nine ounces, and another person said, “About 7 days of your life.” Both answers feel right.
* * *
In the months after my mother died, my father tried to sue her doctors. The doctors should pay for the mistake of her diagnosis that led to her death, as he saw it. Perhaps he was tired of shouldering the blame from his dead wife’s family. Perhaps he would have done this whether or not they’d launched their accusations.
At the time, my father did not tell me about any of this. He did not mention that he had met with lawyers, likely whomever he found in the phone book with the cheapest rate. He did not tell me that he asked Steph to request and review all of our mother’s medical records, though Steph was not yet a doctor.
It surprises me now that I was oblivious to these late nights, which must have stretched for months, with Steph bent over the playbook of our mother’s death, trying to decipher it in order to help our father allocate blame. I wonder if Steph, like our father, appreciated channeling her grief somewhere. I did not notice him, bloated with stress before shuttling into a law office in his old suit, the same one my mother found at T.J. Maxx or Marshalls in the kids section—Your father, he fits into teenaged boy’s clothes and it’s much cheaper and there’s less hemming, she often said. It was the same one he wore to our cousins’ weddings, our school concerts, and her funeral.
I can picture my father laying these stacks of my mother’s medical records on the lawyer’s desk or a conference table with a hope that even if this could not resurrect his dead wife, it might be his redemption.
The first law firm my father tried to hire welcomed him into their office for a meeting. The lawyer listened to him recount my mother’s illness—the shadow on her liver, the scans, how the doctor had told my parents that it was probably fine, his words. The lawyer sat on the case for months and might have continued doing so if my father hadn’t called to say he was taking his business elsewhere.
The second law firm had a former nurse on staff.
You said that your wife lived two years after the discovery of that shadow, right? she asked after listening to my father’s story.
Yes, my father said. Two years ago, they say she had a shadow on her liver.
So two years ago though, she said, these doctors didn’t know about her cancer.
Yes.
But even if they’d diagnosed it as cancer at the time of the shadow, she still might have died nonetheless. In other words: Two years could have been my mother’s life ex
pectancy.
As my father relays this to me in his living room, he shakes his head, still in disbelief after all of this time.
I think they had a similar case that they had just lost, he says, so they didn’t want to take this one on, that’s why she say that.
Did they say that? I ask. About losing the previous similar case.
I think so. My father looks uncertain. I think they say that.
He nods as if to affirm his own story. It’s not that I don’t believe he was told that. It’s not that I don’t think he had a case. It’s that I wonder if this law firm saw he was a man desperate to redirect his grief. When I picture my father trying to scrape together a case for this lawsuit, my throat clogs. I don’t think I’ve told him this—or if anybody has told him this—but I don’t blame him. For trying to sue the doctors, or for what happened.
* * *
Not long after my call with Kau Fu, I stay with Steph at her place in Eastchester. She pulls our mother’s medical records from a desk drawer. The last time she touched our mother’s files was for the attempted lawsuit, and she had written DO NOT THROW OUT in Sharpie on the envelopes in her careful handwriting. I had asked Steph about how, specifically, our mother died. My conversations with my uncle made me realize I couldn’t recall basic things, like where my mother’s cancer had originated.
So here we are. I don’t want to make a big deal out of any of this. Steph warns me that the records don’t reveal much; the cancer had already progressed too far for doctors to confidently discern where it had started. We sit on the floor and I pull the papers from their envelopes. The dates leap out first: October 10, 2004. October 12, 2004. As I reach the records from when you died, October 13, my eyes begin to water. I have never seen these before.
It is incredible how sick you clearly were and how as a child I hadn’t understood. I’d known that you were in the hospital, which would have made it serious—but I didn’t think that this would kill you. You would get sick, and then you would go through treatment, and then you’d be in remission, I’d decided. At thirteen, I was confident that everything could be reversed with another chance. That’s what we were taught in school, and what you and Daddy believed. If you persisted, you could make anything happen. If you worked hard enough, the world was yours. So, yes, you would survive, as far as I knew.
Ah, I say to Steph. I slide the papers back into their envelopes. Maybe we can look at this some other time. There was dinner waiting downstairs and we both had work to attend to later.
Yes, anytime, Steph says, looking relieved.
The next morning, I lay my mother’s medical reports on Steph’s kitchen table and I scan the pages with my phone. I lean over each sheet and study the end of my mother’s life nearly a decade and a half before, page by page.
On your admittance form to Saint Francis Hospital, dated September 30, 2004, the physician writes this:
“Very pleasant 48yo information specialist employed @ Aetna admitted with ascites/pain/fatigue…”
Very pleasant, the doctor described you, the day you learned you had cancer. Were you very pleasant then, as you tried to make sense of this diagnosis?
Very pleasant, the doctor described you, when you were swollen and tired and scared and realizing that the illness you had been fighting for months had actually been killing you.
Very pleasant, the doctor described you, just two weeks before you died.
Sometimes I catch myself on my phone and swiping open the records when I’m bored and my fingers are idle. I don’t notice I’m doing it anymore. I tap on the scanner app while I’m sitting on the couch or waiting for a bus or at the dentist’s office or the dog park and I find myself reading and rereading your autopsy report. My stomach hurts each time. I can’t stop. Eats, feeds, my body struggling to metabolize my loss.
It says your right lung weighs 715 grams, your left 520. “In some sections, the lymphatic tumor spreads down a small distance into the substance of the lung.” The first time I read this, I immediately Google “lymphatic tumor of lung” and I click over to the image results. I find only diagrams instead of photographs of real tumored lungs.
Your liver weighs 1,650 grams and the doctor writes that there is a “grossly nodular feel,” and without searching this online, I know this to mean riddled with tumors.
The report tells me your heart weighs 290 grams. This is the part that punches through the drywall of my chest to squeeze my own.
“The heart is opened in the direction of blood flow,” the report says about yours. “The external configuration is normal.” Normal, sure. But if we’re in the business of defining everything, what exactly is normal? This report is in present tense, which trips me up each time I read it. I think of your heart around right now and resting, present tense, on a little metal scale. Limp, still. 290 grams. Normal? Normal? Normal?
The average human heart weighs about eleven ounces, or 310 grams, and is about the size of a clenched fist. If I’m going off of this very specific measurement—the weight of two navel oranges, the volume of my hand wrapped around two slices of that fruit—then your heart is, was, just a little less than normal, but not by much. Is? Was? If I’m referring to lungs that no longer pump, a liver that no longer works, and a heart that no longer beats, why do the records talk about these pieces of you in the present? Why do I? Maybe your siblings were right. How could your spirit rest with your heart poked and prodded like this?
On your medical record, the doctors indicate that you don’t smoke. An interesting omission that would be revealed as a very obvious lie once they sliced open your chest and examined your lungs during your autopsy. But you weren’t thinking about that when during each doctor’s visit, you shook your head at the question. No, no smoking.
Who cares, you must have thought. The deception would only be figured out after you were dead, so to you, it wasn’t a big deal. Would your medical care have changed? Or would that have made insurance more expensive and killed you faster?
The records list your medications. Dilaudid, which is hydromorphone, an opiate, a painkiller. Reglan. Aldactone. Colace, for constipation.
In high school, when I worked late in the kitchen to memorize physics equations or facts about cellular respiration, I sometimes opened the cabinet where we stored your pills. You’d been dead for months, then years, and we still hadn’t tossed them out. I gripped a bottle and appraised it as though each pill could have saved you if only there’d been the opportunity. But they were just to alleviate your symptoms to make dying easier.
I wonder if—I cut myself off. I wanted to think, I wonder if they could make dying easier for me, but I was too ashamed to let myself finish the sentence.
It took me more than a decade to go looking for the “real” answers. I did not want to learn the gruesome way your body gave up. For so long, I feared that unearthing the real, indisputable facts—and other people’s accounts of what happened—would bring a finality to my grief and, as a result, you.
I imagine your death like this: Your spirit had evacuated your body. It would exit your chest and slip down the emergency slide and into the tarmac of the afterlife while the rest of us were still buckled into our seats and strapped into our own anxieties and about to take off to some predetermined destination. There were no flight attendants to help us and no prerecorded safety videos to let us know what to do in case of emergency.
15.
When you were in the hospital, you called me to your bed.
You’re taking care of the fish, right? You meant the betta fish that we’d brought home a few months earlier. I had dumped him in a vase on our kitchen counter and I named him something generic. Fred or Frank. He was blue-black with purpled fins.
Yes, I told you, I’m taking care of the fish. In truth, I couldn’t tell if Fred or Frank had moved in days—if he’d died and his body hadn’t yet reached the point where it had become buoyant. You were talking in present tense, about the right now, as if the pets would be around for you to take
care of when you came home from the hospital.
And the birds, too?
Yes, and the birds.
And Moo Cow?
Your face was wan, and I clutched your hand. I wondered then if you thought you would never see the cat again, would not say goodbye to him, would never again stand at our back door, thrusting your face up and back and giggling hysterically to yourself as you belted out his name. Yes, and Moo Cow.
You squeezed my fingers and shut your eyes.
Days later, you would be dead. Months later, the fish would be dead. A year or two later, one winter morning, I would not be dead, though I sometimes wished I were. I would instead wake late for school. I could hear the van’s engine roaring outside, the driver laying on her horn every few minutes, annoyed that I was late again. Downstairs nearly all of our parakeets except one lay limp, three bursts of neon greens and blues carpeting the bottom of their cage. The surviving parakeet, Blueberry, squawked and fluttered nervously. I’d had him since I was in kindergarten. The birds had been riddled by some disease or the cold, or both, and I hadn’t noticed. I rushed back and forth to the cage, distraught and peering in while I tossed notebooks into my bag for school. I was stunned at these circumstances, mortified that I caused them, and terrified that all of this, no matter what, was now beyond my control. There was no getting the parakeets back. I ran to my father’s bedroom and flung open his door.
All the birds are dead except Blueberry! I shouted, rushing from the house, not waiting for my father’s response.
Because it was winter and the yard was frozen, my father would not be able to bury the birds in our backyard, like I’d hoped. His shovel would meet ice. So instead, he laid them in a shoe box, their little feathered bodies resting in the garage. We’d have to wait until the ground thawed before the parakeets could have their proper burial.
