by Ann Patchett
At the end we went and sat together at a table where Lucy signed a seemingly endless number of books and I signed a handful. Her fans were a sensitive bunch and many of them bought a copy of my book because I was just sitting there and Lucy was so busy. They slipped her letters and cards; someone brought her flowers. Lucy nodded politely, but her fan mail was too depressing to bear. More often than not it was a one-upmanship of illness, a report from the suffering sweepstakes that would show Lucy how she had not been the winner after all. I tried to read the bag of letters beside her desk once, but by the third one I felt nearly suicidal, as if the world was a blister of grief with only the thinnest layer of tightly stretched skin holding everything in place. The smallest touch, the lightest reminder, and everything was brought to the surface again.
What a shame these people weren’t around in Scotland or during her childhood, through the endless boring hours spent in hospital beds or throwing up after chemotherapy. Now everyone was turning out to take communion in Lucy’s sadness when in fact all we wanted was to get through the line because there was a party to go to, our party, and we had cases of wine and champagne stacked up in the bathtub back on Mercer Street. The sadness, it seemed, was finally over at the exact moment that everyone wanted to share it.
Lucy had hired a student to stand on the street outside her building and open the downstairs door and direct people up the stairs. Stuart had opened up his enormous loft next to hers for dancing while Lucy’s side was for food and conversation, although how much conversation could there be with the music so loud? It seemed that everyone we had ever known from college and Iowa and Provincetown and the Bunting had all moved to New York and they all knew each other in some vague way and were thrilled to be reunited. It was a wonderful party. Our publisher had sent over boxes of our books and they constituted all of our decorations. We gave them out with every glass of wine and signed them with extravagant pledges of love. When we got tired of signing our own books, we signed each other’s. I introduced two of my old boyfriends to one another and they became such good friends that when one of them married years later, the other was his best man. Lucy was yelling at people, trying to make them dance. It was impossible to even think of a party at Lucy’s that did not involve dancing. When she couldn’t get anyone to join her, she turned the Talking Heads up loud and started in by herself. She took to the floor like a firefly, moving so easily I would have thought she was in our kitchen back in Iowa, and still no one would dance, but now she was having fun and she couldn’t have cared less.
Chapter Eleven
IN THE FEW MOMENTS OF MY BUNTING FELLOWSHIP when I wasn’t in New York or in the pool at Harvard, I was doing research for a nonfiction book I planned to write about the Los Angeles Police Department. Since I had to be out of my apartment in Cambridge at the end of August, I decided I would use Nashville as home base until I finished up the book tour for Taft and then I would head west. But once I got back to Tennessee, I met a man named Karl VanDevender, whom my mother worked for. After a few dates, I decided we were having such a nice time that it wouldn’t hurt to delay my plans. It would be all the same if I left in a few weeks. Then it was a few months. I took an apartment with a six-month lease, and then I renewed the lease.
I certainly did not set out to find a man of whom my best friend would approve, but Karl was Lucy’s dream come true. He was older, he was kind, he was handsome, he was intelligent, he was generous, and most importantly, he was a doctor. Lucy’s relationship to doctors was as complicated and nuanced as her medical history. They were the ultimate father figures of her youth and for a few kind words about how brave she was, she would gladly neglect to mention her pain. They were the busy, important men (and all of the pivotal doctors in Lucy’s life, to the best of my knowledge, were men) who occasionally sat on her bed and stroked her forehead, handsome men who for the briefest moment paid all of their valuable attention to her. They told her she was the most remarkable case they had seen and made promises of how they would shepherd her through to a better life. The surgeons stoked her deepest dreams of repair like coal men shoveling fuel into a roaring furnace. They told her not to worry about the money, and then presented her with enormous bills. They told her it would take three surgeries over six months, only to discover it was ten surgeries over three years. There were wonderful doctors, full of compassion and innovation, but they never seemed able to consider any surgery but the one they were about to perform. They never took her lifetime into account or figured in the enormous costs, physically, financially, and emotionally, of all that had failed so dismally before. They didn’t account for Lucy, only for her face. And maybe they couldn’t. She was too huge for casual consideration. But how can you operate on the face without understanding what the face means to the girl? How can the meaning of kissing, swallowing, speaking, be completely ignored in favor of mechanics? The doctors took what they needed from her body, sometimes without ever mentioning it, so even though her head was swollen beyond recognition, what she cried over was the scar running up her leg where some surgeon had taken a vein without asking. She loved her pretty legs.
But these were the doctors I felt kindly towards, the ones who, even if they couldn’t see the bigger picture, genuinely wanted to help her. There were another kind as well, the ones for whom Lucy was a super-star challenge, the ones who had a new vascular technique to try out, the ones with no follow-through but a large prescription of OxyContin. Those were the ones she called cowboys because there was always a trace of a swagger in their fast walk. They didn’t answer questions or return calls, and whatever flash of attention they gave was born of noblesse oblige. Their dance cards were booked a year in advance and whatever you got you were lucky to have. The hospital hallways were full of them.
But Lucy was a victim neither of neglect nor good intentions. She was absolutely complicit with her doctors. She always meant for surgeons to see her as both a viable candidate and an amazing case, and she was extremely careful never to reveal the depths of her hope or despair to them. Lucy, who lacked obedience in nearly all matters, was as mute as a first-year novice when a doctor spoke. She went to the hospital when she was told. If she had fears or hesitations, she confided in her friends, not her doctors. More than anything she wanted to be the special patient, the favorite, the best. Not only was her case the most compelling, she was the most agreeable. While doctors were often still the dream fathers, now they were the dream dates as well, busy, powerful men peering into her pale blue eyes with pen lights. She fell in love with them and longed for them to fall in love with her. Once Lucy gave a lecture to a convention of plastic surgeons and one came up to her later and suggested she come by his office for a consultation. He had some new ideas that he thought could help her. They made love on the examining table.
“It was my ultimate fantasy,” she said. “Except for the part about him being married and an asshole.”
Those two points aside, she went back several times. I thought it was nothing short of a miracle that he didn’t bill her.
There was still the penultimate fantasy, the one about the father instead of the lover. In this fantasy the doctor tells all his other patients to go home. He has as much time as she could possibly need to say everything she ever wanted to say, to ask every question no matter how trivial or embarrassing it might seem. Then he would invite her home for dinner. His wife and children love her so much they give her the daughter’s bedroom. That was the doctor Lucy found in Karl.
I brought Karl to New York to meet Lucy in October of 1994. We agreed to have brunch at a restaurant called the Cupping Room a few blocks away from Lucy’s apartment. It was cold and wet and the place was packed full of fat coats taking up extra chairs and the hooks on the walls. Lucy was late, and as I sat there with Karl, I thought maybe I had made a mistake. If she didn’t like him, she would tell me and I didn’t think I wanted to know. Karl assured me he had met plenty of people in his life and most of them liked him fine.
Ten minutes
later Lucy came in pink with fever. Her hair and skin were slightly damp and she was packed into several sweaters. I made the introductions. “I’m sick,” she announced as she sat down at the table next to Karl, and she was. She should have been home in bed but she had come out for me, not wanting to miss the chance to meet my new boyfriend.
Karl ordered her tea and rested two fingers on the inside of her wrist. After a minute he touched her forehead.
“I get pneumonia,” she said. “Everything goes into my lungs.”
And so Karl scooted his chair out and, in that crowded restaurant and before there was any conversation, laid his ear against her back and told her to breathe in. When she did, she looked at me, at first as if to say, What the hell? but when she exhaled she smiled. It was charming, after all, to have a handsome man press his head to your back so soon upon meeting.
“Your lungs are fine,” he said.
“Pancakes,” she said to the waitress, “undercooked.” Then she blew her nose. Karl held out his hand for the Kleenex.
“You want to look in my Kleenex?” she said.
I thought it was going a little too far, but in that moment Lucy blossomed. No one had ever asked to see the contents of her tissue, she told me later, in a hospital or out, though at several points in her life she had hoped that someone would be interested.
Karl wanted to hear Lucy’s entire medical history, which was a little bit like asking to hear the political history of China over eggs and toast. He stopped her frequently to ask more questions, to encourage her to make the story longer. We had all day. We could stay through dinner, until they turned the chairs over on the tables and pushed us out with a broom. When the conversation came up to the present, Lucy said that she thought the surgeries were essentially over. They should be over. Except she still needed teeth.
Teeth were always going to be the final chapter of Lucy’s surgical history, but no matter how many operations she had they always seemed to hang just outside her reach. She had lost all of her lower teeth and most of her upper teeth save the front ones in the endless rounds of childhood radiation. Life since the age of ten had been spent mashing soft food against the roof of her mouth with her tongue and swallowing what she could with sips of water. She was prone to choking and once had her life saved with a dramatic Heimlich maneuver performed by the poet Tom Lux in a New York steak house. She could have gotten teeth in Scotland, she said, had she been willing to stay there for God only knew how much longer, but that would have constituted another brand of defeat. In the States, teeth were considered a dental matter, even if they had all fallen out due to cancer of the jaw. Dental implants were only covered by dental insurance, something Lucy, like most writers, had never dreamed of having. A single implanted tooth could cost up to $1,500, and there was no way she was ever going to come up with that kind of money.
“We’ll get you teeth,” Karl said.
“You can’t just get a person teeth,” Lucy said.
Karl thought she was wrong and he shook his head slightly, as if it were simply a matter of picking up the check for lunch. “I bring people a lot of business, the hospital, other doctors,” he said. “People would be glad to do me a favor if I asked. And if worse came to worst, I’d just pay for it myself.”
Lucy was exasperated by Karl’s reasoning, nearly angry. “You can’t make something sound so easy when I haven’t been able to do it my whole life,” she said. “It isn’t easy. It’s impossible.”
“If it’s only a matter of money and finding someone to do it, then it’s easy.”
After hours and hours of talking, the three of us walked to a pharmacy in the rain and Karl got Lucy some antibiotics to combat the fever and what he considered to be the suspicious contents of her Kleenex. Then we took her back to her apartment and tucked her in for a nap. After we left, I wondered how well I knew Karl. Like Lucy, I found the promise to be uncomfortably extravagant.
A month later Karl sent her a plane ticket to come to Nashville. He had lined up some people to talk to her about teeth.
MY MOTHER HAD an extremely ratty old black cat named Slick that none of us much cared for. I put the cat in the past tense, even though he is at this moment still alive. He is eighteen, half blind, and down to three teeth. The very fact that he shows up for his can of food in the mornings continues to surprise us. The cat loved Lucy, who loved the cat. She would carry him from room to room in my mother’s house and beat her open palms rhythmically against his sides. It looked and sounded very much like abuse the way she pounded on him as if he were a dusty couch pillow pinned to a clothesline, but the cat adored his beatings. He purred in rapture, butting her hand with his head whenever she had gotten tired of the game.
I am taking care of a cat for the cat’s protection league, a different one than the last I wrote about. This one was a mess when he came. I’ve never seen anything so terrified, so lost. He wouldn’t eat, wouldn’t play, would only cram himself into the darkest hole he could find. I’ve spent a lot of time with him, though, and he’s really changed. He purrs and plays and is curious: I feel like a proud cat psychiatrist. It’s good to be reminded that you can do small positive things which make a difference in the world, however small they are. He still won’t let you pick him up easily, he seems convinced that every time I go near him I want to make cat stew, but once I get him he is really sweet, curling up around my neck like a scarf and purring in sheer gratitude that I didn’t hurt him.
Lucy knew which cat wanted to be held and which one wanted to be smacked. The weight she put on things so often struck me as backwards, but in some ways she had a deep understanding of the logic of the world. I would have thought that the prospect of getting teeth after twenty years spent without them would have been thrilling or daunting, but she shrugged it off. She had no interest in obsessing over possible outcomes. She would simply go and see what they had to say and that was all there was to do. And she was right.
The oral surgeon sat us down in his office and gave us a glossy book of dental implant surgery. The process was explained to us while we followed along with the pictures. Basically, a metal stake would be implanted into the jaw, one for every tooth. It was a shining hook that jutted up from an angry red gum, the prototype for some as-yet-to-be-written horror film in which the fearsome murderer chews his victims to ribbons. After that, a second surgery attached the tooth to the claw, so forth and so on, a couple of teeth at a time.
“Good God,” Lucy said.
“Isn’t there another way to go about this?” I asked.
“A denture maybe,” she said.
The doctor put Lucy back in the chair and filled her mouth with a bright light. He told me to come around the other side and look. She couldn’t open wide at all, but what I could see was a rocky cave, the place where the loose ends of every surgery carelessly came together.
“You can see here there isn’t any sort of a plate you could attach a denture to. There’s nothing really for it to sit on. It would have to be implants, and even those are going to be tricky.”
After he left, Lucy sat up in the pale blue vinyl chair. She unfastened her paper bib from its clip and held it in her hands. She looked shaky and then, in the smallest way, she started to cry.
“I feel so ashamed,” she said.
“Ashamed?” I sat down next to her on the sloping seat of the dental chair. “What could you be ashamed of?”
“I’ve never let a friend look inside my mouth before.”
Was that possible? Had I never seen the inside of Lucy’s mouth? Was there really still something I hadn’t seen?
The oral surgeon sent us to the plastic surgeon, which is where we should have started had we wanted to save everyone some time. She took an X ray of Lucy’s jaw and slid it up on the light board. There were twisted pieces of wire holding bone together and spikes in a few of her teeth I didn’t know were implants. There was the delicate ghost of the necklace she was wearing. The surgeon, who was pretty and friendly and blond, took a plastic
pen out of the pocket of her lab coat and pointed to the mess of her lower jaw. “You don’t want implants,” she said. “They’d break what’s left of the bone getting them in, or if they did get them in, you’d break your jaw chewing. This jaw isn’t meant for chewing.”
“So what’s the alternative?” Lucy said.
The doctor clicked off the light switch and handed her the image of herself. “My best advice is to keep going exactly the way you’ve been going for as long as you can, unless you want to do another bone graft to build up the lower jaw enough to sink the implants.”
It was the kind of news that was easier to take in Tennessee than it would have been in New York. She could pass these doctors off as a couple of rubes who didn’t know all the magic the big guns were working back in the city. The trick was finding the right doctor, someone who was fearless and innovative, someone who was willing to risk everything Lucy had, the same way she was willing to risk herself. She tossed the X ray into the backseat of my car.
“Do you mind if I keep that?” I asked her.
She told me she’d be flattered and when we got back to my apartment, we put it up on the refrigerator. There was something about that X ray that looked more like Lucy to me than any picture I had seen.
“I’ll call Karl,” I told her. “He’ll know what to do next.”
“There’s nothing to do next,” she said. She didn’t seem especially disappointed. She had been right after all. Karl had underestimated just how complicated she was.
“There’s going to be something else to do,” I said. I called Karl at his office and told him what had happened.
“Oh, well,” he said. “We tried.”
But hadn’t he been sure? Hadn’t he looked her in the eye and said he could make this happen? “Isn’t there someone else we can talk to?”
