OPERATION: Total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, bilateral sentinel lymph node biopsy, omental biopsy, pelvic washing.
PROCEDURE: The patient was prepped and draped in the dorsal lithotomy position with pneumatic boots, antibiotics, Foley catheter, V-care and heparin. The skin was entered through an abdominal incision and a careful abdominal survey was performed. Sentinel nodes were identified and removed using the pinpoint system. The uterus, cervix, tubes, ovaries and omentum were all drawn out through the vaginal canal without difficulty.
COMPLICATIONS: There were no complications.
PATHOLOGY: Endometrial adenocarcinoma, grade 2. Slight lymphovascular space invasion is identified (multiple levels were examined on selected slides). Grade 2 is based on the presence of rare atypical, possibly serous cells but more likely of the endometrioid type.
FOLLOW-UP CARE: It is anticipated that the surgery will result in complete recovery. Possible adjuvant referral for radiation pending further examination of tumor.
I should have known right away. I’m in the medical profession, for God’s sake, I’d coded enough of these stories in the past twenty years. I saw blood in the toilet, more than there should have been and at the wrong times. For a day or two I tried to convince myself that it was only a precursor to menopause, my hormones going on the blink—what I’d heard a doctor describe once as “one last egg in the basket.” Well, then, so maybe I had multiple last eggs. I knew it really wasn’t a good sign, though, so I called my doctor’s office. When I told the nurse what was going on, she had me come in that afternoon.
The doctor sent me straight to ob-gyn for a biopsy, and they sped up the results out of professional courtesy, since I’d done their coding for years. Four days later I got the call. “Unfortunately, they found some cancer cells in your sample,” the young gynecologist told me. Her voice sounded fragile, and I wondered how many times she’d had to deliver such news, either in person or on the phone. Probably not many, in her short career. I felt sorry for her.
Then, as with an audio delay, I heard what she had said. After hearing it, it took me a few more seconds to understand that “some cancer cells” = “cancer.” Some cancer cells was a code, I realized, intended to make the blow a little easier when the patient registered the words.
I appreciated this. And it worked. Instead of immediate panic, I slid into understanding far more gently than if she’d said, You have cancer.
I didn’t tell Will at first. The diagnosis came in April of his junior year—a little more than two years ago, now. We’d had the worst winter in Boston of all time, almost a hundred and ten inches of snow, a bunch of blizzards and missed school days, everybody hibernating under the impression that it was never going to end. I remember that the snow in our yard came up to my chest. By the middle of March, Will was as weary of it as I was, but somehow he found what it took to keep up with and even exceed the academic goals he’d laid out for himself. Those next couple of months were important; he needed his highest grades if he had any hope of getting into the colleges he had his heart set on because of their psychobiology programs. His schoolwork had suffered from his emetophobia, though his grades were still better than those of most of his class; that’s how smart he is. Still, the guidance counselor told him at the beginning of that spring semester that he’d need to buckle down and give his best effort between then and June, and I was determined to do everything I could to support him in that.
Not telling him meant, of course, that I also had to put off the surgery. But I figured a short delay like that wouldn’t make a difference. The risk was worth it—I knew how disruptive it would be if I told him I was sick, he wouldn’t be able to concentrate on his chemistry or his stats. I was afraid it might paralyze him.
Back when he was in middle school, around the time his stomach problems started, he told me he was afraid that if he didn’t check every single thing off his long to-do list, which he refreshed every day, something bad would happen. “Like what?” I’d asked.
He shrugged, but it was a shrug filled with worry. “I don’t know. Like suddenly I won’t be able to do anything, anymore. It would be like stepping off a train track, and not being allowed to get back on.”
“But honey,” I said, “That’s too much pressure to put on yourself. There’s no train, no tracks. And even if there were, there’s no such thing as not being able to get back on.”
Of course, I know better now. But I didn’t, back then.
“I know,” he said, but I could tell it didn’t help any, he still felt what he felt.
I tried again, remembering suddenly the quote on one of the tai chi posters in his bedroom. “Or I guess what I’m trying to say is, ‘There’s more than one path up the mountain.’”
He nodded. “Okay.” I should have known he would have tried those mental strategies already, the things he’d started to learn from tai chi. He added, “Thanks,” which broke my heart a little, because I knew I hadn’t helped him at all.
I waited until his finals were over, then sat him down to use the same words the young gynecologist had used with me. “They found some cancer cells, but I’m meeting with a surgeon who’ll take them out.” This was the middle of June, almost exactly two years ago, now that I think about it. Two convicted murderers had broken out of a maximum-security prison in upstate New York a week earlier, and despite the intense manhunt reported all over the news, they’d managed to elude capture. One of the search members admitted in an interview that “they could be anywhere.” So even though we lived a few hundred miles away, everybody was feeling a little bit tense.
When I told him that I’d had a biopsy revealing some cancer cells, Will drew his fingers into a fist. “Why’d you go to the doctor?” he asked. “Did something hurt?”
“No. I was bleeding.”
“I never saw any blood. You didn’t have any bandages.” I recognized that this was his way of resisting what I’d told him, of suggesting that maybe the doctors were wrong.
“Well, it wasn’t . . . external.” I watched it dawn on him, and he flushed quickly. “Oh.”
My kind of cancer was a good kind if you had to have it, I told him. Most of the time, surgery alone is a cure. The lab at the hospital had sent my sample to the surgeon I’d be seeing next week, so we’d know more then, but probably the operation would take care of it.
“I’m coming with you to the appointment,” he said.
I told him he didn’t have to do that, I was planning to ask Grettie.
“We’ll all go.” He waved away my objection like so much white noise, and I knew I couldn’t deny him.
I’d told him the truth; I did plan to ask Grettie to drive me to the appointment with the surgeon. What I hadn’t said was that Grettie didn’t know about the cancer yet. I’d wanted to tell her, but it didn’t feel right for her to know before Will did.
Who am I kidding, there was another reason, too. I waited to tell her because, same as with the night in the cemetery, I was afraid she might not have as strong a reaction to the news as I wanted—needed—her to have. I needed her to be afraid, both for and with me. I wanted to know that my cancer mattered to her not just because we were friends, but because she didn’t want to lose me.
As it turned out, I got more than I was hoping for. “You’ve known this for two months?” she said, stopping cold after I managed to get the words out while we were taking the dogs for a walk. Her eyes were flashing. I know I shouldn’t admit that her anger excited me, but it did.
I told her it wasn’t just her, I’d waited to tell Will, too. I said I was sorry, which seemed to inflame her even more. “Don’t be sorry to me! Be sorry to yourself, for God’s sake. Be sorry to him.”
I would have felt better if she’d said something like You should be sorry, what would I do without you? But I could tell that’s what she was thinking. Or something like it.
We still hadn’t resumed the walk with the dogs, who both strained against their leashes. “For God’s sake, Roberta.” She only ever uses my full name when she’s mad at me or trying to make a point. “Since when do you keep something this big, and this scary, to yourself?”
And there it was: my Gretchen Question! I knew she had no idea about the nerve she touched—the nerve she perforated. She meant why hadn’t I told her about the cancer, I got that, but to me the question went a lot deeper, and shook me to the core.
I learned about it in college, in a course on Romantic texts. The Gretchen Question—in German, die Gretchenfrage—is the one you don’t want to answer because it exposes the thing you most want to conceal. It comes from the scene that depicts Faust refusing to answer his own Gretchen, when she asks if he believes in God. He hems and haws his response, because he can’t let her know he’s made a deal with the Devil.
The original Gretchenfrage was about religion, but my professor said it became more general over time. So for one person, the Gretchen Question might be “You’re telling me you chose wine over having children?” For another, “Did you recognize the harm you were causing, but went ahead anyway?”
The stakes in a Gretchen Question are high, when you go to answer. Telling the truth is risky; you might give too much of yourself away.
And what was my answer? Not to her question about the cancer—that one was easy, I just said it had been a shock, I needed time to absorb it for myself.
But I couldn’t stop thinking about the other thing, the thing Grettie didn’t know enough to ask about. The truth I’d never told anyone. What I really wanted to say to her was If you only knew!
I met her as a freshman at UMass, answering the ad she placed for a roommate in the apartment she rented when she began her graduate program in political science. I was too late for a dorm assignment because we hadn’t thought I could afford to go to college, but at the last minute my mother asked her aunt for more money and then there I was, needing a place to live.
I saw immediately that Grettie was a different creature from me. It wasn’t just that she was so smart, although that was part of it. She’d grown up in New York City, eating in Thai and Indian and Vietnamese restaurants. Central Massachusetts, where I grew up, was not all that far away in terms of miles, but the closest I’d come to an international meal was stir-fry in a Styrofoam container from the Chinese counter in the food court at our mall. Grettie had traveled to Europe and Asia. She was not afraid to try things like snorkeling, and she had double-pierced ears.
Part of it had to do with money, of course. But it was more than that: the real difference had to do with how she carried herself, and how she moved through the world. I tended to hunch over, sit toward the back of rooms, and do my best to shrink. The therapist told me once that when he looked at me, he saw a person who didn’t believe she deserved the space she occupied. What could I tell him? He was right.
But Grettie: she walked tall with her shoulders back, took in whatever she needed, and plopped her body and belongings down in the middle of whatever room she entered. She was a center in herself. How better to say it? I wanted to orbit her.
My luck in finding the ad, then being chosen by her, was something I felt grateful for every day. (I still do.) Over pizza in our kitchen the night I learned about Faust’s Gretchen, I asked if that’s where her name had come from. No, Grettie said, though she knew the story, despite the fact that her field was politics and not literature. She told me her parents had named her for the Clever Gretchen in an old European fairy tale. “And thank God,” she added, “the Faust one kills her baby and goes insane, right?” I nodded, knowing she must be right—she knew so much, she was so clever—though we hadn’t reached that part of the story in class.
Even in college, even without knowing what the question would be, I hoped that someone would care enough about me to ask me die Gretchenfrage someday. That it turned out to be Grettie seemed perfectly right and made me feel all the more grateful, even though I couldn’t show it in any way. Since when do you keep something this big, and this scary, to yourself? I had to do the same as Faust, avoid giving an answer. Hem and haw. Of course Grettie noticed, but by then the dogs were pulling us, and the question got lost in the bustle along the path.
She and Will and I went into the city together to meet with the surgeon my medical friends had told me was the best. The room they showed us to, to wait for her, was so tiny it only had an examining table and one chair. I sat on the table, Grettie sat on the chair, and Will leaned against the wall next to the hazardous-materials bin. When the surgeon and her intern entered, Grettie gave up her seat, and I could see how agitated she felt that there was no room for her to pace even a few steps as we all waited for Dr. Venn to speak.
They’d had their pathologists review the biopsy, she told me—standard procedure when they received a sample from somewhere else. A team of six pathologists altogether, she said, had taken a second look.
“Six,” Grettie exhaled, and I knew it had been involuntary; she would have kept it in if she could. Against the wall, Will made a little movement with his arms—the beginning of one of his tai chi postures, I saw—then quickly folded them as if otherwise they’d continue with a mind of their own.
Embrace the Moon, I knew that motion was called. Every time I saw Will do it, I thought of a pregnant woman cradling her belly. The pull-cord for emergencies dangled right next to his arm, and when I had a sudden vision of him giving it a violent yank, I gasped a little myself.
“That’s not unusual,” Dr. Venn said, misreading the reason for my gasp. They liked to make sure there was agreement, she added. The six pathologists had almost come to terms—only one wouldn’t sign off—in concluding that the cells in my sample were the most benign kind, well-differentiated and less likely to metastasize than the two other types. She pulled out a little chart and pointed to the different cell images. Instead of really focusing on them I asked, “Ha, is that your Venn diagram?” and she tried her best to give me a little smile. Behind her, I saw Grettie biting her lip.
She would do the surgery the following week or the week after, Dr. Venn told me; she’d have her scheduler call. And we’d know more after that, because at that point they’d have the whole tumor to look at.
Did we have any questions? The surgeon turned to include Grettie and Will.
Will asked, “Is she going to die?” Too late to do any good, I shook my head at him.
“He’s just worried,” I told the surgeon. “He knows you can’t answer that.”
Will said, “No, I don’t.”
Dr. Venn smiled at all of us, but I could tell she hadn’t expected this direct question from my son. “We don’t have an overwhelming reason to think that’s something we have to consider right now. It depends on what the lab says about the type of cells we find, but we’re hoping your mom won’t need anything further after the surgery. Possibly a mild course of radiation, but it may be that all she needs are follow-up exams for five years. You’re in high school, right? What year?”
“Senior. In the fall,” Will said.
“Well, then, let’s hope that by the time you graduate from college, her follow-ups will be just about over, and she can go back to seeing her primary once a year. This will all be a distant memory.”
How I wish, now, that she hadn’t said that! She’d been cautious: We don’t have an overwhelming reason. It may be. Let’s hope. But of course it was everything that followed those words that Will focused on. Your mom won’t need anything further. I could tell that he and Grettie were relieved, and I allowed myself to feel it, too. “In the meantime, let’s take things a step at a time,” Dr. Venn said. “Okay?”
She was asking all of us to let her and the intern go. Grettie and I thanked her; Will stared at her but said nothing, which seemed to unnerve the surgeon a little. When we were alone in the room again, Grettie said, “I think it all
sounds pretty encouraging. And she’s scheduling the surgery soon, which is good.”
“Yes.” None of us wondered out loud if scheduling it soon might mean something to worry about. “I can’t wait to get it over with.”
Grettie and Will took care of me together. The surgery was on June twenty-eighth, the same day the police arrested the second of the escaped convicts in New York; they’d shot and killed the first guy two days earlier, not even fifty miles from the prison. Only fifty miles, after being on the lam for three weeks! I took this as a good omen, a kind of metaphor: the cancer cells had broken out in my body and caused some trouble, there was a panic, but they didn’t get very far before they were captured, everybody would be safe now.
Grettie picked us up early in the morning to make the treacherous rush-hour drive into Boston, which she never seems to mind. She’s driven in Rome and Australia, and she scoots around in her brother-in-law’s Citroën whenever they go over to Ireland—it’s nothing to her, whereas I just wait for every car coming in the opposite direction to swerve into mine. Like I said, nervous Nellie.
The hospital my surgery was performed in is nothing like the small one I do—did—the coding for, it’s like an entire city within itself. Will and Grettie waited nearly all day for me while I was in pre-op, surgery, and the recovery room. Later, I asked him how they’d spent all those hours. Playing games in the family lounge, he told me: checkers, Monopoly, Crazy Eights. What did you talk about? I asked.
He shrugged. “You know. You, the surgery. How long would it take, how long before the anesthesia would wear off, stuff like that. Just, whatever.”
Grettie had a different story, though I could tell she hesitated to mention it, with me in my fragile state. But I told her I could handle it, I wanted to know. She sighed and said, “Okay. He asked if I could tell him anything about his father.” When I gave a start, she said, “See? I should have waited to tell you.”
The Gretchen Question Page 4
