Passing

by Michael Korda

  In keeping with the atmosphere of the place Dr. de Lotbinière himself appeared to greet us, rather than our being ushered into his office by his nurse or one of the receptionists. He was tall, well dressed, courteous, cheerful, even jovial, there was nothing forbidding about him at all. I could not help noticing that he wore a well-cut suit rather than a white doctor’s coat, and narrow, elegant, beautiful polished shoes, looking every inch like what an old Rosean should be. He charmed Margaret at once, treating her as if she were a guest to a party. I thought he might be about to kiss her hand—at school we had been expected to kiss the hand of the headmaster’s wife every evening as we filed out after dinner—but instead he gestured her toward the most comfortable chair. I gave him the disk of Margaret’s brain scan, and he turned to his right to study it. His computer was off to one side, so the three of us sat comfortably looking at each other, as if we were about to have tea. When he wanted us to look at something I stood up and looked over his left shoulder, while Margaret, who was closer, remained seated as he isolated a feature and enlarged it for us. His manner was calm and reassuring, unlike the previous neurosurgeon we had seen he was informative and low-key, and he succeeded at once in thawing Margaret. She had not even wanted to look at the scan the last time it had been shown to her, in fact she had kept her eyes firmly shut, but this time she looked at it attentively, and even asked a few questions. He answered them quietly, without drama, his description of the tumor not so very different from that of the radiologist’s report, although shaded a little more gently.

  Of course, Margaret had not read that report, which was buried on my desk, so she was hearing about it in detail for the first time. Coming from Dr. D it did not appear to frighten her, she listened calmly, without any evidence of anxiety, her chin resting on her hand—he could hardly have had a more perfect “bedside manner,” the old-fashioned way of describing a doctor who knows how to talk to a patient, had he been a general practitioner on a house call telling her to take a couple of aspirin, spend a day or two in bed and take plenty of liquids, rather than a brain surgeon with the full range of modern science and surgery at his fingertips. No doubt he realized at once how much Margaret feared and hated the idea of becoming a patient, acted upon rather than acting, giving up control, handing over to him or anyone else with a stethoscope the life she had built for herself so carefully over the years. She had a natural reluctance to put that life in the hands of any doctor, even one so gentle and charming in manner, a reluctance intensified by a lifelong fear of the medical profession, but she was struggling to overcome it. She would henceforth call him “Dr. Alain” to avoid the difficulty of pronouncing his last name.

  Why was he against her having a biopsy? she asked. He gave a gentle shrug. At this point it doesn’t matter what kind of tumor it is, he told her, what matters is to remove it at once. When that has been done, it will be biopsied, of course, but the important thing now was to remove it. There was no point in making two holes in the skull, one for a biopsy, another later on for surgery. In addition, there was always some danger that the biopsy might cause a hemorrhage as it pierced the tumor, so why run the risk? That made evident good sense to me, and apparently to Margaret too. There is, in fact, an old neurosurgeon’s adage, “It’s much more important to know where something is than what it is.” I had found this searching on the internet about neurosurgery, and clearly it still held true.

  It was apparent from her questions that Margaret had reconciled herself to the surgery. She had decided to trust Dr. Alain, and as I well knew, once she made a decision she never looked back on it. How long would the surgery take? she wanted to know. At least four hours, maybe more. We must understand that this was major surgery—he firmly emphasized the word. Gently, he touched the left side of her head with his fingertips a couple of inches above the ear and indicated a sweeping crescent with his index finger. He would make an incision here, lift out a piece of the skull, then remove as much of the tumor as he could. Margaret did not flinch, she merely asked how much of her hair she would lose. Dr. Alain took this in his stride, he was a man of the world, he did not dismiss Margaret’s concern for her hair. He would merely have to remove a narrow strip of hair, he reassured her, indicating about an inch with his thumb and forefinger. She nodded. He had passed the first test.

  The next would be harder, I guessed. Would she ever be able to do the things she loved, riding, taking long walks, dinner with friends? she asked. This was the nitty-gritty for Margaret, I knew that.

  Unlike the previous neurosurgeon, Dr. Alain kept eye contact with his patient, he looked at Margaret steadily and with sympathy. The aim was to restore and preserve her quality of life, he replied. Coming from Dr. Alain, the words “quality of life” sounded more like a promise, however qualified, than a threat. There were risks associated with this kind of surgery, it would be foolish to deny it, he went on, there could be no guarantee, but he saw no reason why she should not eventually resume doing the things she loved.

  He did not overburden Margaret with the physical details of the surgery he would perform; she did not want to know them, nor probably do most other patients facing brain surgery. She already guessed without being told that despite the precision and delicacy involved in performing a craniotomy and the resection of a brain tumor, it was still a bloody and challenging procedure. If you let your mind wander there, you only have to imagine the surgeon cutting through your scalp, drilling holes into your skull, sawing between them, removing a piece of it, then cutting into that portion of your brain where speech, right hand movement, and so much more of what is “yourself” are contained—what neurosurgeons call the “eloquent” portion of the brain. Margaret was consenting, whether she knew it or not, to let Dr. Alain perform surgery in the part of her brain that defined and controlled the very essence of who she was.

  Of course, whenever a surgeon needs to operate you cannot help imagining what life will be like if things go wrong, leaving to one side the question of whether you survive, but with brain surgery you also have to wonder whether you will emerge from it as the person you were—not just whether you will be able to ride a horse, drive a car, cook dinner, or play Scrabble, but whether your memories, your feelings, your sense of self will be intact. What if some or all of that intricate web of knowledge, experience, character, personal tastes, and personality is lost in the process, who, what will you be? To Dr. Alain’s credit, he did not play down the risks, but he somehow managed to make it clear that he was on her side—not a threatening medical authority figure, but a friend. In these circumstances this was no mean achievement.

  At home, while Margaret was asleep, I had watched some parts of a color videotape of a craniotomy performed by Dr. Brett Osborn, which was boldly, and as I soon learned accurately, marked with the warning, “This is not for the faint-hearted.” That was putting it mildly. Once the skull is opened, brain surgery is a delicate art—it must take nerves of steel and the fingers of a concert pianist to cut into the brain itself—but opening the skull resembles carpentry carried out with a high-speed drill in a torrent of blood, saline solution, and fine bone dust. Watching Dr. Osborn, a passionate weight lifter and motorcyclist, drill half-inch holes in the skull, saw between them to detach a piece of it, then lift it out to reveal the brain below was an amazing but gruesome experience for a layman, at any rate it was for me. Imagining this being done to someone you love (and keeping it to yourself) is harder still.

  Having gained Margaret’s confidence, Dr. Alain skillfully gave us a brisk foretaste of the future. He would perform the surgery at Westchester Medical Center University Hospital (henceforth referred to as WMC), in Valhalla, New York, which was just over an hour away from our farm by car. After surgery Margaret would have to spend a few days—it was impossible to predict how many—in the Neurological Intensive Care Unit. Margaret wanted to know how long it would be before she could go home. Dr. Alain patiently deflected this question. It was impossible to say for sure. She might benefit from a peri
od of rehabilitation, a transition toward her return home. I could see from Margaret’s expression that this was going to be a sticking point, and so could Dr. Alain, who waved it away—we would have to see how much progress Margaret made in the Neuro-ICU. Once she was home, she would need some level of outpatient rehabilitation therapy, either at home or at a local hospital, and once she had sufficiently recovered he would administer “Gamma Knife radiation,” a very precisely targeted radiation intended to kill any remaining cancer cells in the “bed” of the tumor, that is to say the place in the brain from which the tumor had been removed.

  The word knife caused Margaret to frown momentarily, but in fact no knife was involved, he explained, it was a painless and simple process, she should have no anxiety about it. He moved from Margaret’s brain scan on his computer screen to his calendar. He would be able to perform the surgery in two weeks’ time, on Wednesday, April 20. I had hoped it would be sooner, but Wednesday was the day on which he operated, and his schedule was already full for next week. I expected Margaret to object or to ask a few more questions, but instead she just looked intently at Dr. Alain and said, “Wednesday is good for me.”

  And that was that. I knew Margaret well enough to tell that she had made up her mind, and nothing would change it—nothing ever changed her mind once she had made it up. Whatever her misgivings, she had accepted that she was going to have the surgery, and she had decided on Dr. Alain, there would be no doctor shopping, no hesitation, no second thoughts. Once Margaret had decided to take a fence she rode full-tilt at it, without fear, without doubt. Her motto had always been that of the great American horseman Harry deLeyer (rider of the famous show jumper Snowman): “Throw your heart over the fence and the horse will follow.”

  Neither of us had any idea how high that fence would be.

  3.

  If you don’t know where you are going, any road will take you there.

  —LEWIS CARROLL,

  Alice’s Adventures in Wonderland

  IT SEEMED TO me that the time between our visit to Dr. de Lotbinière and the day set for Margaret’s surgery at WMC in Valhalla would stretch endlessly. I wondered how we would cope over the next twelve days with the suspense and the anxiety, not to speak of the fear that Margaret might die before the surgery if the expanding tumor caused a hemorrhage between now and then. But in fact the next twelve days would turn out to be so busy that we scarcely had time to worry.

  Preparing for brain surgery is like setting out for the longest and most challenging of journeys. You make lists, fill out forms, try to decide what to pack and how to deal with everything that will be left behind while on a long voyage the destination of which remains unclear.

  Dr. D’s patient secretary Bonnie had provided me with a mass of paperwork, as well as a long list of things we must do to prepare for surgery. Perhaps the most reassuring information was that Medicare, plus my secondary coverage, UnitedHealthcare, would pick up about 90 percent of the cost. The financial office of WMC was blissfully vague about what the total would amount to since Medicare would cover most of it, but gentle prodding, aided by a quick scan on the internet, indicated that it would run into the mid–six figures—in fact, the bills for Margaret’s first brain surgery would eventually come to about $450,000—leading me to realize how fortunate I was to have made a smooth, indeed effortless transition from the excellent health coverage I had enjoyed for forty-eight years at Simon & Schuster to my retirement and Medicare. Given my Medicare number and that of my secondary insurance, nobody at WMC or in Dr. Alain’s office was concerned about my ability to pay for whatever was in store; there were no complications, no anguished telephone calls, no disputes about what was covered and what was not, no red tape or fuss. As the statements began to come in over the months ahead, it was difficult not to wonder how the mere fact of having had a good job and living until the age of sixty-five separated me from the many millions of people for whom this level of medical treatment would either be impossible or lead to bankruptcy. All you had to do was live to the right age and in a part of the country where there is no shortage of good, even great hospitals, to be almost totally covered, whatever happened. I gave silent thanks to President Lyndon B. Johnson, who put through Medicare in 1965, and gets little credit for it, and to those who have kept it intact since then despite efforts to diminish it.

  I cleared my desk of its normal clutter and put everything down in some sort of priority, while Margaret went upstairs to her own office, a converted bedroom above my office where she kept the filing cabinets containing her horses’ paperwork over the years, and the bulky files for each of the annual Stonegate Cross-Country Schooling Trials, which she had put on for the last twenty-five years. At their peak Margaret had as many as 150 horses and riders competing at three levels—Beginner-Novice, Novice, and Training—over courses she had designed herself, not to speak of everything that goes with a combined training event: USCTA technical delegate, almost fifty volunteer fence judges with walkie-talkies, a sound system and an announcer, a vet, a blacksmith, an EMT with an ambulance, a caterer, a secretary to check every competitor’s entry forms, people to oversee the parking of trucks and horse trailers (and tow them out with a tractor if it got muddy), a starter, and an assistant with an electronic stopwatch to record times—in short, a huge effort that kept her fully occupied all winter. It was also a year-round task to maintain and improve over fifty fences and keep the courses free of rocks or woodchuck holes.

  Even in bad weather Margaret hated to be indoors. She was happiest outdoors, walking her land when she was not riding on it—a farmer’s daughter, as comfortable in muddy Wellies as in high heels. People who didn’t know her well assumed that she spent her time riding or getting herself ready to go out to dinner, without realizing that she was also the chief executive and organizer of a large-scale horse event that took place at the beginning of May every year regardless of weather, required nearly a year of preparation, and always made a profit, or that she regarded her horses, her barn, and every acre of our land as her personal responsibility. When it came to what was hers, Margaret’s eye was on the sparrow.

  I half-heartedly emailed replies to a few friends who knew that Margaret had been going down to see Dr. de Lotbinière, all variations on the same message: “We have been consulting with brain surgeons, and have chosen one, and Margaret will have surgery on Wednesday next week . . . Of course, time is of the essence, the clock is ticking, but I think we have a very good man, and there is an excellent chance he will remove all the tumor, then we’ll see . . .”

  I did not add that I was shit-scared.

  I assumed Margaret was sending similar messages to her friends upstairs from her cell phone, but after a time I heard what sounded like an electric appliance instead. A Dustbuster, perhaps? But why would Margaret be vacuuming? I left my desk and climbed the steep, narrow staircase to her office, made more challenging by a ninety-degree turn midway—it had not yet occurred to me that she might very soon not be able to get up to it again—to find her at her desk feeding photographs into her paper shredder. There were boxes and thick files full of photographs on the desk, one of them of her first husband Donald Williams in front of her—she always referred to him as “the good-looking one” among her three husbands. “Don was good-looking,” I said, glancing at it. “Yes, he was,” Margaret said, as she slipped his photograph into the shredder with no visible emotion.

  Margaret’s marriage to Don was something of a mystery. In 1955, at the age of eighteen she graduated from a hum-drum secretarial school in London and made the surprising decision to take a job in Kenya, then still a Crown colony, while the Mau Mau Uprising against British rule was still going on. It was in effect a war zone, as well as a journey of three days and nights from England by air, via Rome, Khartoum, and Entebbe in a twin-engine, propeller-driven aircraft. The job she was going to was that of a secretary in the Criminal Investigation Department of the Royal Kenya Police in Nyeri, a small town in the middle of the heavily f
orested Aberdare highlands about sixty miles as the crow flies from Nairobi, the heartland of the uprising.

  No doubt Margaret had craved something more exciting than a secretarial job at home in England, and her father would surely have encouraged her to find one—Paul Mogford had always regretted not going out to farm in Canada or Australia when he was a young man, so he would have been the last person to hold his daughter back from a colonial adventure.

  In Nyeri Margaret shared a cottage on the golf course with another secretary, and carried a Luger pistol in the waistband of her skirt, as well as a boxer on a leash, whenever she went for a walk—not uncommon precautions during the Mau Mau “emergency.” The pistol was surely loaned to Margaret by her boss and future husband, the handsome young district police commissioner of Nyeri, who also taught her to shoot it—she would remain an excellent pistol shot until her illness, admired at the Pleasant Valley pistol range for more than her looks.

  At what point she and Don Williams became lovers it is impossible to know, but less than a year after her arrival in Kenya they were married at Saint Cuthbert’s Church in Nyeri, a full-scale colonial wedding with Margaret in white and Don in dress uniform, photographed as they emerged from the church under crossed swords, with kilted bagpipers in the background, bound for the wedding reception at the famous Outspan Hotel.