Mary Cappello

by Swallow: Foreign Bodies

  In forty-seven cases of children the child was crying when the foreign body

  was inspirited. The natural purpose of the crying of children is to make a

  noise. In the usual forms of crying in children, the noisy phonation is kept

  up throughout a prolonged expiration. This is followed by sudden, deep,

  violent inspiration, the necessity being urgent to cut short the relatively

  silent inspiration, in order to resume the noisy phase as quickly as possible.

  This sudden, deep, violent inspiration seems to be one of the most common

  factors in the etiology of foreign bodies in the air passages of children.

  Crying is mentioned in only three of esophageal cases. (DAFP, 22)

  When one has seen patients of 8 or 9 years of age climbing on to the operation table of their own accord, submitting to the washing out of a bronchiectatic cavity through a bronchoscope and irrigator, and then getting down and walking away smiling, one is brought to the conclusion that there is, in some cases, an advantage in using this comparatively peaceful method in place of the struggle and dread of a general anesthetic.

  —V.E. NEGUS, “The Course of Endoscopy in Chevalier Jackson’s Service” (1924)

  Fbdy #565, the Case of Margaret Derryberry: Objects Lost and Found and Lost Again

  “We met in California, we were married in Mississippi, lived in Tennessee, and our kids were born in Kentucky.” It could be the beginning of a song, starting in Pennsylvania, but it was part of a story that eighty-three-year-old Margaret Derryberry was telling me about how she and her husband had found one another, and about her life, which was, she explained, a series of blessings, including her finding a mate who proved to be “a perfect husband—as perfect as a person can be.”

  Margaret Derryberry and I hadn’t literally met, but we crossed the threshold of the Mütter Museum coincidentally. I’d fantasized about the possibility of finding someone who was connected to one of the objects in the collection, someone still living who might have been treated by Jackson and who could share her experience with me. In the same week that I’d made one of my first official visits to the Mütter archives, I guess you could say I had been blessed, because that was the week Margaret called the museum in search of the hatpin she had aspirated in 1931, when she was eight years old.

  At first I was incredulous—both her name, Margaret Derryberry, and her e-mail address, cobwob@aol.com, seemed made up. I couldn’t even find “cobwob” in the OED, but, running a Google Books search, I struck upon a line in Alexander Pope’s “Epistle to Dr. Arbuthnot, Being the Prologue to the Satires,” in which it had appeared as an early variant of “cobweb”: “Who shames a Scribbler! I break one cobwob thro’/He spins the slight self-pleasing thread anew.” On second glance, applying a digital magnifier, I saw that Pope hadn’t used the word “cobwob” after all. Nor did Samuel Butler, Robert Burns, or the many other presumed cobwobbers sited by Google Books, but the search tool consistently mis-read some early type-faces’ nearly closed “e’s” as “o’s.” Searching and finding, losing and searching again, Margaret Derryberry (who was Margaret Billig when she had her foreign-body accident) and I formed a fast familiarity with one another.

  “Sincerely.” “With fond regards.” “Forever thankfully yours.” I don’t know at what precise point we started to sign our letters with the word “Love,” because our conversation had begun with the simple sharing of a story, the recounting of an accident, the production of a ghost:

  We were visiting friends in Catawissa, Pennsylvania, where we had once lived. And the girl was about my age, and she had this bunch of hatpins, I don’t know why. And we were playing with them, we were up in the bedroom. And my mother wanted me to go across the bridge and play with the children while she went shopping with the mother. And I was very unhappy about that, and I started to cry. And Mom was firm, she said no, you’re going with your sisters across and play. But I cried so hard, and I put my hands up to my face. I sobbed, hard. One little cough. And I was standing there looking at my hands, and mother asked me, what was wrong? And I said, I had a hatpin in my hands and it’s not there now.... I didn’t feel it, I didn’t know it was down there. I just knew I did that little cough.... Everybody was down on their hands and knees except Mother and me looking for the pin in the rugs . . . but they took me over to Danville and they X-rayed me and they saw where it was and they said they couldn’t do it, and they sent us to the University of Pennsylvania.

  The firmness of a mother meets the inspiration of a child gulping air in protest of a leave-taking. Is it out of politeness or an attempt at self-comfort, this tendency to bring our hands up to our faces or up to our mouths when we cry?

  This is what Margaret Derryberry remembers: root-beer floats. A carton of milk. A baby doll. The other kids were promised root-beer floats for the trip but not Margaret. A carton of milk soured in the car without her having any, and she didn’t understand why she wasn’t allowed to eat or why the car had to be driven to Philadelphia so slowly, avoiding any bumps. She knew the pin had disappeared, but because she could not feel it inside her, it was almost as though nothing at all had occurred: nothing at all, and yet something potentially grave.

  I don’t know if Margaret had been wearing her play shirt or a favorite check dress with matching translucent apron when she was driven from her friend and their playful interlude, driven all the way to Philadelphia, but she remembers that it must have been summertime because she was in short sleeves and ankle socks (see figure 32). Her mother knew Margaret to be honest and good—she believed her, while the others had reverted to all fours, searching out the pin inside a carpet—but she was also exasperated: “I can’t take you anywhere!” In response to that global pronouncement, Margaret remembered thinking, “I don’t remember going anywhere and causing trouble.” Margaret vividly recalls certain impressions from her experience in one of Jackson’s clinics, while other things she only remembers being told in the experience’s aftermath, and she retrospectively understands some details anew because she grew up to be a nurse, which was another blessing: it was a line of work she’d fallen into but grew entirely to love.

  A white sheet, the glint of silver metal. Bits and pieces waft back from the recovery room that Margaret remembers sharing with a little baby who had a cast on “because she had congenital dislocation of the hips,” and a girl who was strapped to a board a couple of times a day with her head down while a doctor slapped her on the back. “And I think now, she probably had cystic fibrosis. You know, that was postural drainage,” Margaret explains. “Bless her heart, she felt so important ... how she strutted! . . . I don’t imagine she’s with us now.” Margaret remembers being told that it was because of Chevalier Jackson that her life had been saved—he had just recently designed the particular bronchoscope his assistant used to retrieve the pin, without anesthesia. Otherwise they would have had to perform a bronchotomy. Jackson didn’t actually perform the procedure; her family was told he was in Europe at the time. She remembers her mother asking for the pin afterwards: “I think after everything was over and done with, she was so relieved that she wanted the pin to show to people what I had inhaled. And they told her, I don’t know how they told her, I’m sure they told her in a nice way, that they would like to keep it for the display case.”

  Fig. 32. Margaret Derryberry (née Billig) about the age she was when she accidentally inhaled the hatpin that was removed from her bronchus in one of Jackson’s clinics. Photo courtesy of Margaret Derryberry and her daughter, Peggy Derryberry Gould.

  At the center of Margaret Derryberry’s interview with me, the recurring pivot point of our conversation is not so much memory’s scattered remnants, however instructive or delightful they might be. What Margaret can’t remember is the keynote of what she shares with me, what she entirely cannot get over, a gap and an absence that she desperately wishes to understand, and to which she repeatedly returns, and that is the fact that she cannot remember bein
g at all afraid. “Because you know something else strange about this? Never did I have a minute of fear or anxiety,” she tells me early on, and then repeats at numerous junctures in our talk:

  “I can’t understand not being afraid.”

  “But I just can’t get over the fact that I wasn’t even slightly alarmed.”

  “And I think I’d have a memory of it. You know, something like that would stick with me.”

  “But what impressed me overall was the fact that I can’t remember any fear at all. And I thought, if I had had anesthetic, you know I could understand it a little. But no fear at all.”

  “I just cannot remember anything frightening about it.”

  This gap or lapse or absence of feeling might explain another conundrum: why, after all these years, did Margaret go looking for that once aspirated hatpin? What motivates anyone blithely, resignedly, to give up the goods to the Jackson clinics or insist on keeping their foreign body Thing? Margaret’s mother certainly understood the newfound importance of the object she wasn’t allowed to keep: she kept a duplicate pinned inside the lining of her purse, which she brought out for visitors from time to time to show them what Margaret had survived. Eventually, she discarded it—or, as Margaret put it, she “finally got rid of it”—but only after a number of years had passed. “She’d bring it out and show it to people . . . like it was some kind of an achievement,” Margaret jokes.

  Margaret’s own search for the pin wasn’t something that occurred to her during her training as a nurse at Geisinger Hospital, where she might have gone looking for the X-ray. It was the computer that prompted her search, she tells me, though in recent years she had mused with her daughter about whatever might have happened to that pin. Yet I suspect what may really have necessitated Margaret’s quest was the incompleteness, the indecipherable missing link, the gap between what she must have experienced but couldn’t recall that is the defining matrix of trauma. Margaret had been in search of the evidence of her experience—her embodiment and her survival, the mark of her having lived, not died, the trace of peril and salvation. She hadn’t felt the pin go in; one minute it was there, and the next minute it was gone, a part of her. Nor did she see it coming out. Though it was lost inside her body, she could not feel it there. Even when it was removed, she didn’t see it and does not remember feeling what would have been an appropriate reaction—fear. Did the pin even exist? The X-ray said it did. The clinicians should have thought to show her the pin. Many years hence, in trauma’s aftermath, perhaps the pin could tell her how to feel. The pin as the mark of having been happened to, having been acted upon, having felt fear and longing and sadness too (that sob).

  “I was crying so hard,” she said, “and when I cry hard, I sob hard.” She went on: “And you know something, this might not interest you, but on the way home, my mother brought my baby doll. And I was sitting in the backseat of the car, and I was undressing my doll, and dressing her. And I took the little pin out of the back of her dress and put it in my mouth, and started to undress her. And I could remember Mother turning around, she didn’t say a word, she reached back slowly and yanked that pin. So I guess I did give her problems I can’t remember!”

  In only a matter of months, my correspondence with Margaret Derryberry had become frequent and fascinating and gemlike; I was caught up in it, as I was with all of my new discoveries about Jackson. I couldn’t quite believe I’d found her, or she me, and we considered our meeting something that was strangely destined. But trauma is more swift-footed than our attempts to keep it at bay, it takes us out of ourselves and it takes us off guard, so I didn’t tell Margaret right away when, just two months after our first interview, I found a lump in my breast and had to be ushered into a full and long-term treatment regime for cancer. My diagnosis was in June, but I waited until late July to craft a letter to her. “If you don’t hear from me, then, it’s only because I’ve been temporarily required to take un unexpected turn in life’s labyrnthe (a word I’ve suddenly forgotten how to spell),” I tried to joke as I drew my letter to her to a close. I told her that I thought the cancer, instead of throwing me entirely off course, might deepen my relationship to the medical matters I’d be contemplating in my work on Jackson, because “cancer, after all, is a sort of ‘foreign body,’ isn’t it?” I asked.

  What had Margaret felt when she saw her foreign body for the first time after seventy-five years of missing it? The Mütter Museum’s educational director had miraculously managed to locate Margaret’s pin and generously photographed it alongside a penny to give her a sense of its size. Jackson’s accompanying foreign-body grid was meticulous and thorough at the level of technique and in describing the problem the case presented, but it did not include identifying details like the date or the name of the patient. For those details, one would need access to the case report, which, in Margaret Derryberry’s case was, as far as I could tell, no longer extant. Did Margaret finally feel that long-deferred fear? I hadn’t thought to ask her exactly what she felt when she found her pin, perhaps because I hadn’t yet had the experience of a foreign body myself. The moment was ghoulish when, teetering and out of it, I was asked if I’d like to see the X-ray that had just been taken of my chest, complete with a foreign body inside: the chemotherapy port and its accompanying spaghetti-string catheter that had been implanted in my chest. My stitches were fresh and I was still woozy from pain medication when I was brought to stand like a drunk before a kind of mirror (and yet not quite a mirror) and gaze at an image that was so familiar from my work on Jackson: the upper torso spookily interrupted by an object breaking its horizon. Though I felt far from grandiose, there was something martyrlike about the scenario, as though I’d been punished for studying foreign-body ingestion by captors who forced one inside me and then made me look: “You want to see a foreign body? Here’s a foreign body!” Much later, upon its removal, the surgeon exclaimed how beautiful the pouch was that my body had formed to accommodate the port. I did not see the pouch, but I asked to keep the port.

  Cancer made me aware of a new foreign-body calculus, because even if we haven’t ingested a foreign body, my work and my life were teaching me that none of us is immune. Can cancer be understood as a foreign body produced by the body? The body made alien to itself? Is cancer’s genesis the effect of having ingested or aspirated something foreign to the body, something that it could not assimilate? Cancer offered a new lesson about my conception of that which is alien to the body: so long as it is still excisable, it can be understood as a foreign body inside the body, but once it becomes more fully constitutive of the body, it is no longer foreign, and therefore deadly. In this sense, the “foreign” of “foreign bodies” is still compatible with the body; it’s when the distinction collapses that the body does as well. By this account, a thing’s foreignness to the body isn’t what makes it threatening, but its ability to confuse itself with the body and thus cease to be foreign: to become the body. Or its ability to simulate the body and therefore displace it. A tumor is a foreign body with a blood supply.

  I shared my news, such as it was, with Margaret on July 21, and looking back on it, it appears I strutted: “I’m sorry to have to share such news with you, but the main thing I wish for you to know is that my book on Chevalier Jackson will get written, and it will get published. I have no doubt about that.” Once I was lost, and now I was found. This wasn’t how I felt in cancer’s wake. It was more like once I knew things, and now I know nothing, even though the sentence I wrote to Margaret seems so insistent and in control. When I met Margaret, I was knowledgeable but innocent, and in a few months, I was wise because truly, admittedly dumb.

  What I couldn’t know (so much that I can never know) and did not know was that I had waited too long to write my letter, because on July 19, Margaret had fallen and broken her hip, and on August 4, her daughter wrote to tell me that she had died: “Margaret went peacefully.” And I sobbed and sobbed. How could my conversation with her not continue, especially now, when I nee
ded her most? How had I missed the chance to give her a parting message or gift? How could I go into the operating room as a patient the next day with the knowledge that my new friend was no longer in the world?

  When Margaret Derryberry found her lost object, she didn’t just recover a particle of the vast universe of matter; she imagined having found, in a sense, her self. “We’re in drawer number seventy. We’re item 565 in drawer number seventy” was how she put it to me. She marked “the pin that’s mine,” “my pin I circled in red.” When Margaret was alive, I tried to discover more information relating to her case to give to her, but I came up short every time I went digging and sifting through the extant case studies in all of the archives I had explored. Wanting to bring the pin back and back and back—and no doubt Margaret, too—I recently looked for the description of the case in Jackson’s Diseases of the Air and Food Passages of Foreign-Body Origin. Using one of Jackson’s guides is always gratifying for the way this fits into that and that fits into this. You bring your finger to the index, find case number 565, go to page 13, and read: the patient was eight years old, the head of the pin had been in the left main bronchus for two days, a 7mm tube had been used with no anaesthetic, the point was buried in the tracheal wall, a side-curved forceps was called upon in the case, the extraction took all of one minute and sixteen seconds. The grid also noted “a hemorrhage from pin-point puncture” that Margaret had no memory of—chalking it up, again, to the miracle-working acts of the Jackson clinic. But this time I noticed something I hadn’t noticed at the beginning of my research: a small-case parenthetical note that read: “Fig. 5, Plate 1.” I gasped: Jackson had illustrated Margaret’s case for this book. I imagined how thrilled Margaret would have been to know this—to see her eight-year-old insides, complete with fbdy, as depicted by the master himself; I imagined writing her family even before I’d flipped to the page. I couldn’t wait to read what Jackson had to say about this case. I yelped to see that he made not just one but two illustrations of it: illustrations number five and number ten, placed one above the other, distinguished by the streak of blood that ran like a rivulet past the vocal cords from the point of puncture (see figure 33). “Girl aged eight years,” his notation read, “steel shawl-pin with head in left main bronchus, the point in tracheal wall above orifice of right bronchus. A tiny stream of blood is seen to be carried by the cilia toward the posterior wall of the trachea. Peroral bronchoscopic removal. Cure” (description of plate 1, DAFP).