Five Women (40 page)

Gara scheduled her first reconstruction to take place over the Easter holiday, so it would seem normal to her patients (and everyone else) for her to “go away.” She was starting to look better. She'd had her destroyed hair cut off in the very short little-boy bob she now noticed on so many middle-aged women who were not waif models, and which suddenly seemed to hint of secrets she had never before suspected. It's the chemo cut, she thought to herself; does she or doesn't she?

The surgery was done under general anesthesia because Gara's plastic surgeon had to make a pocket for the implant underneath the chest muscles, and she felt it would be too painful under a local. “It's not like breast augmentation,” Dr. Lister had said. “It's much more precise, because you don't have a breast to go over it and cover up any imperfections of placement.” Dr. Lister had chosen silicone for her despite the furor that was currently surrounding it. “If a patient has a breast to go on top of it, I use saline,” she said, “but it's too wrinkly and bouncy for you. If you had saline your breast would look like a pool toy.”

“A pool toy!” Gara said, and she had to laugh. “But is silicone safe?”

“I've taken silicone implants out of women who've had them for thirty years,” Dr. Lister said. “They're very strong, and they don't leak. The ones that used to kill women were when doctors put shots of silicone directly into their breasts, in little clumps, and it would wander to their lungs and organs. There really is no proof that the new one's cause autoimmune disease. Since the lawsuits, only one company has been chosen to manufacture silicone implants now, and to get one for you I have to put you on a protocol. All that means is you come in for checkups, which you would do anyway.”

“But what about the women who did have problems and won their lawsuits?” Gara asked.

“I still think you'll be safe.”

“Okay,” Gara said, because she really wasn't afraid.

The company who made her implant was the same one that had manufactured her expander. They examined it carefully and had no idea why it had been defective.

After her surgery Gara went to Jane's, enjoyed being pampered for a few days, and then went home, impatient to be independent. She had a drain again, but this time she didn't mind, because it was temporary, and she also had a round young breast, which was permanent. A nipple would have to be made later, sculpted from her chest skin, and the nipple and aureole would be tattooed to duplicate her real one in color. This was a new technique and Gara was glad they had discovered it; formerly the nipple had been made from a little piece cut from the patient's vulva, and the very idea made her cringe. Why hurt in two places when you could hurt in only one? She would also have to have her real breast lifted so they would match.

The artificial breast sat on her chest like half an orange, because that was its nature, while the real one looked deflated. Now Gara was putting the polyester she had saved into her bra on the right side. In the summer, when she had her month off, Gara had her remaining breast lifted and rounded to match it to the new one, and a small saline implant put in to complete the transformation. Before all this happened it would never have occurred to her to have her breasts lifted; it seemed too vain, something for a movie star to do, but now that she'd had it done she wondered why she hadn't done it years ago. They still didn't really match, and they weren't quite the same height, but those changes would be made later in yet another operation.

“They never match the first time,” Dr. Lister said. “If you'd had a double mastectomy they would be perfect, but there are just too many variables when one is real.”

It takes one operation to lop it off, Gara thought, and six to put it back on.

Blue Shield refused to pay for either of her hospital stays for reconstruction, with various excuses ranging from not paying for plastic surgery to incomplete information about the dates she had been in the hospital and how many pieces of equipment had been used. She was covered as an inpatient, and they kept insisting she had been an outpatient. She immediately started to worry, even though she kept telling herself it was bad for her health not to stay calm, and the worry increased. There were delays, letters sent back and forth, repeated phone calls made by Gara to people whose names she wrote down and couldn't reach again, who kept asking for hospital and surgery records the hospital insisted had been supplied and which they said they never received. She went higher up and finally found a woman who she was able to talk to every time, but it did no good anyway, except that this one acted nicer. The hospital accused the insurance company of lying and delaying, and the insurance company accused the hospital of the same thing. Now Gara had copies of her records, of files, of correspondence, but she still owed thousands of dollars and she wasn't even finished with all her surgery.

Every month the hospital sent her bills with increasingly stern computer printouts on them. “Hospital bills are
your
responsibility,” they kept reminding her. “We will have to take legal measures.” She knew she had the coverage; it said so in her contract. Why didn't her insurance provider provide it?

Finally, after a year, when the hospital thought she was a deadbeat and she was too stubborn to prove to them otherwise, they wrote to her and threatened to send a collection agency to get their money from her, to take away her home, her car, to ruin her credit rating. Sometimes now she found herself trembling with rage at the injustice of all this bureaucracy, because it was being used against people who had been ill and still feared for their lives, and because many of them really had no money and were probably terrified.

A man from the collection agency wrote to her telling her to call him to straighten this out before she got into trouble. Gara called him. “Why are you persecuting me?” she said. “I'm a sick woman, I have cancer, I don't need stress. Stress will give me cancer again.”

He seemed sympathetic, a little nervous. “Well, I wouldn't want to make you sick again,” he said. He kept her on the phone for forty-five minutes telling her how he disliked the system, telling her horror stories of other patients who had not paid their bills, and how the insurance companies had made their lives a living hell. Then he offered to give her another month if she would get after the hospital. A month later they went through the same thing. She thought that having to listen to him telling her the same stories for forty-five minutes was part of the living hell.

When it was time for her next surgical improvement Dr. Lister put her into another hospital, where they didn't know a bill collector was after her, and which Dr. Lister thought Blue Shield might be more inclined to pay. Blue Shield wouldn't pay them, either. Then the new hospital said they would send a collection agency unless she started paying a little bit every month, so she did. She wondered how women who had been mutilated the way she had been ever could afford to be made normal-looking again, and thought how unfair it was to add this financial worry to everything they were going through. When they told you that you had cancer they told you that you might die, but they didn't mention that you would also go broke.

She hired a lawyer, finally, who wrote a stern letter to the CEO at Blue Shield, pointing out how they were harassing a sick and vulnerable person, causing her stress, which in her condition was to be avoided. They paid her first disputed hospital bill immediately, and the second one eventually.

She had recovered from the effects of her chemotherapy, and her youthful and healthy-looking face had reappeared as if it had never been away. Everyone asked her if she'd had a face lift. That was when Gara really understood how debilitated she had looked under chemo; no one had told her she looked sick, but now they told her, surprised, that she looked wonderful, and asked what she had done. As a bonus her hair had grown back thicker than ever. She wanted time to go faster so she could reach her five-year survival mark and feel safe, but at the same time she wanted it to go slowly so she could savor the good things about each day. She wanted all her reconstructive surgery to be finished so she could forget about it, but she knew she would never forget about it. She looked different than she had before, and she always would.

Her insurance company wrote to tell her the rules had been changed: she could buy a Major Medical policy now without being turned down for a pre-existing condition, with no questions asked; this was the policy she had been turned down for years before because she had ripped her knee ligaments in aerobics class and had been in physical therapy for a while. A little late, Gara thought, but she bought the policy. This time, if she had cancer, they would pay for almost everything. I hope I never need it, she thought.

She didn't think about cancer all the time the way she had in the beginning. There were many hours when she forgot about it entirely. Looking at herself after her shower, she had to remember. Getting dressed, she remembered. Hearing about women she had known who did not survive it—and there
were
those, who always seemed to have their recurrence unexpectedly—she was filled with fear. When she went for her checkups and blood tests, first every three months, then every four, then finally every six, she was only frightened for the week before she went to the doctor's office, wondering if this time her reprieve would be denied.

A married friend she had known years ago in Paris, when she and Carl had been married, passed through New York on business, alone, and invited her out for a drink. Carl had married Lucie, he told her. They had a little girl, named Adrienne, after the painter friend who was her godmother.

I wish I could see a picture, Gara thought, and then, no, I don't. I don't know these people. They are no longer in my life.

“Carl speaks French fluently now,” the friend said. “But remember how awful his accent was? It's still awful.” She knew he was trying to make her smile, but he only made her sad. “The baby is bilingual,” he went on, “as most French children are.”

“She's American,” Gara said. “Her father is American.”

“Of course. You're looking great. Better than ever. You know, we all liked you much more than we like Lucie. She's a child, really, very shallow. Some women always remain children, no matter how old they are.”

And some don't, Gara thought.

“I'll be in New York for a week,” he said. “Why don't you call me and we'll have dinner?”

“All right,” she said, but she never did. Dinner took too long. They would talk about the old days, or the new ones, about things she didn't want to think about or know about. She wanted closure. Carl's marriage should provide it, but she still had to be careful not to ask for information, not to live vicariously, only to remember that they both had secrets from one another, which was as it should be because they were no longer even friends.

Gara was not looking for a man anymore. She wasn't ready yet, and wondered when she would be, if ever. She felt too vulnerable, too afraid of being rejected. She knew of women who had been left by their husbands and lovers when they got cancer, because the men said they were afraid to watch them die. What if she met a man like that—fearful, insisting on promises kept? What if she met one who thought her body was ugly, and wouldn't wait around long enough to care about her in the first place? She still needed time to heal in many ways, and she knew she was atypical in hiding what had happened to her, that most women with breast cancer went public as soon as they knew they had a chance to survive, became activists, told friends and strangers in an effort to help others and themselves.

An unhappy childhood is the wound that never heals, Gara told herself. All these years she had told her patients it took time to uncover the past, and then to understand it, and finally to get safely beyond the harm that had been done—to develop a kind of scar tissue, but she couldn't seem to do it herself. May had brought her up to be perfect, or at least to pretend to be and fool people. The mother who had forced her to sit at lunch with a bottle of smelling salts under her napkin so the boy she didn't like wouldn't tell his mother she had fainted and was therefore imperfect and undateable and unmarriageable and unlovable had taught her too well.

Spring came. Gara was a three-year survivor. Her odds were getting better all the time. “You
had
cancer,” Dr. Beddowes told her cheerfully. “You don't
have
it, you
had
it. Think of it that way. See you in six months.”

“Of course.”

“I have news,” Jane told her on the phone. She did not sound at all happy. “We're moving to Singapore.”

“Moving?” Gara's heart turned over. “To that place where they
cane
people?”

“They don't cane women.”

“Oh, great. How long will you be there?”

“I don't know. Eliot has a TV series that's going to be made there. An hour once a week. If it's a hit we may be there for years. I have to go with him, or I won't have a marriage, but I hate everything about the idea. I'll miss my family and friends, I'll miss you terribly. It's too hot there, I mean really, really hot, and you go to prison if you drink anything alcoholic, and I won't know anybody.”

“Sure you can drink,” Gara said. “It's the home of the Singapore Sling.”

She was used to Jane's absences on location, but they had always been known to be temporary, finite, an adventure. This sounded ominous. What would she do without her best friend, now that she was all alone? Maybe the series wouldn't be a hit. She didn't want to wish them bad luck, but she knew Jane was hoping the same thing. “Why would he want to live there anyway?” Gara asked.

“I don't know. He says it's an opportunity. He's excited.” Jane sighed. “He says he's tired of Hollywood and wants to do something different.”