The Instant When Everything is Perfect (6 page)

Who knew how grief could turn a cell against the body that made it?

A line has formed at the registration desk because the clerk is flirting with a man, taking her time swiping his card and laughing, tilting her head just so to show off her long lovely jaw line. Two women here for varicose vein surgery turn to each other and cluck, clutching their paperwork. The television flickers on, news, all disastrous. The weather will turn, winds will tear down power lines and delay traffic. The president will start another war, either in some underdeveloped country or here, at home, between gays and straights, conservatives and liberals, businessmen and environmentalists. The Congress and Senate will battle over the budget that is so far in deficit, Sally can’t even begin to imagine what the number would look like written down. Schoolchildren will lose years in a horrid educational system. Katherine will sit at home in Philadelphia in front of the screen and yell
Fuck them! Fuck them
!

On and on it will go until the nurse swings open the door and calls out, “Sally Tillier.”

Three

Robert

Robert puts down the recorder, clicking pause, and stares at the chart in front of him. His last patient, Jackie Lagalante, has just had her final check up after her TRAM flap reconstruction. It wasn’t easy. In fact, when Jackie came in for her first consult and then later, after she’d gone through chemotherapy and radiation, she was thin, her bones like hooks under her skin. But she was a good consumer—she’d watched the videos carefully, and saw that the TRAM gave the best results. Breasts that were of her own skin, own flesh, supple, and natural.

“I want those,” she’d said, the bangs from her wig dipping down over her eyes. “These are the breasts I want.”

Robert didn’t know what to say, except, “You’re too thin.”

Jackie stared at him, blinking once, twice. “Then I’ll gain weight. I’ll grow the fat for my own breasts, and you’ll move it from my stomach to the right place. I read about it. It can happen.”

In his other life, Robert would have said, “Yes,” immediately, assuring Jackie that all of this was possible, and maybe more. These new breasts would be shapelier, better formed, and feel better than anything she could get with an implant. And certainly, this newly grown flesh would be cancer free, not prey to the disease that flowed in her lobes and ducts. He would have extolled the virtues of nipple tattoo and given out the phone numbers of former patients whom she could call for glowing reports on his technique, bedside manner, and wise counsel.

But he was not in his other life now, so what he did was to nod and agree with her plan. They could do it. It would work. And her TRAM flap was, as it turned out, successful. But he didn’t promise anything. He never does, anymore.

He clicks back on the recorder. “Patient was recommended to continue with her onocological check-ups and tests and was told to make an appointment if she notices any tissue loss.”

Robert turns off the recorder, pushes his hair off his forehead, and picks up the appointment schedule his assistant Carla prints out each morning. Sally Tillier. From last week. Impending double mastectomy. Thin, too, like Jackie Lagalante.

He puts down the schedule, rubs his forehead. Sally Tillier brought her daughter to her last appointment, probably because of something she’d read in a book about having an advocate. Probably the Breast Surgery Nursing Coordinator counseled Sally to bring another set of eyes and ears to every appointment. Sometimes Robert wants to open the door wide and shoo the family member/advocate out of the door, hustling them and their little notebooks and tape recorders out of the office. Too many eyes, too many ears. But he liked the daughter, felt it in his face when he opened the door, a flush of blood at what? A kindred soul? Someone who might understand what had happened to him? Her face made him want to smile and cry. He recognized her, a complete stranger. “There you are,” he almost said. “Where in the hell have you been?”

Robert sits back in his chair, shaking his head. Right. His parted twin walked in into one of his exam rooms, just like that. Maybe it was just that the daughter seemed like someone who would never ask for a procedure as trivial as a forehead peel or liposuction or a chin implant? Someone who would never swish into his office, sit down, and talk about having a “little cosmetic maintenance.”

He doesn’t know what his reaction was all about, but when he’d seen her—what was her name? Had he written it on the chart?--she reminded him of a taste, something like caramel, rich and thick and sweet.

For the first time that day, Robert Groszmann, M.D. is excited to see a patient.

He tries not to look at the daughter, Mia Alden, too often. He is conscious of focusing on Sally while she talks, nodding, blinking once, twice, and then turning to Mia for a quick, natural affirmation of Sally’s words. Mia is never looking at him, her eyes on Sally’s face, but he can tell that she sees his glance, her peripheral vision catching his gaze. Her face seems flushed, high colored. He looks back at Sally, listens, wondering how old Mia is. Her skin shows, as the current lotion ads say, the signs of aging. Small crow’s feet by her eyes, the slight grooves running from her nose to lips, lines that will slowly deepen with time. But she has no eyelid droop, no need for a Blepharoplasty; no excess skin under her chin. She’s had no work done, not ever.

She’s not wearing a wedding ring, and there is no tan line where one should be. But her last name is different than Sally’s. So maybe she’s divorced or separated. Robert stares at his chart, wondering what went wrong with her marriage. Or, he thinks, she just doesn’t wear a ring. A choice? She’s not old enough to be a hippie, throwing out all social norms. Perhaps she just took it off for today, to send him a message.

She’s got to be thirty-eight. Maybe forty?

“So what do you think?” Sally glares at him, her dark eyes glinting.

Robert pushes his hair back, blinks, reads the actual words he wrote on the chart, and then looks up. “What I’m hearing you say is that you do not like the way a mastectomy deformity looks.”

“God no! All those lumps and bumps in the wrong places.”

“Those people,” Robert says, “were fat. Overweight. Considerably. You wouldn’t have a result like that.”

Mia laughs, shifts in her chair. “Lucky it’s you and not me, Mom.”

Robert swallows, unable to believe he said the word fat. Why not obese? Overweight? Clinical terms. He glances at Mia, who is still blushing.

Sally waves her hand. “It’s just so ugly. But I can live with it until I heal from the first surgery. Then I want it done. An A cup, just like we discussed.”

Robert writes down what she says, knowing that the appointment is just about over. He won’t see Sally Tillier or Mia Alden for months now, not until after Sally has had her mastectomy, undergone chemo or radiation treatments, and healed. Maybe, as sometimes happens, a woman as practical and conscientious as Sally Tillier would decide that her mastectomy deformity is quite livable, doable, the prostheses just fine. With her new bra and the soft, malleable prosthetics, no one knows her secret. She could walk and travel and even date without anyone knowing. After the cancer, the idea of additional surgery, further hospitalization and office visits and worry might seem ridiculous.

Robert might get a call or a message from Sally, saying she’s changed her mind. Or she might just never call again, the idea of even stepping in the building too much to bear.

Robert taps his pen on the chart, nodding. “I think that’s the right decision for you. I do want to do a few additional measurements before you leave.”

“Should I tell Dr. Jacobs?”

“I’ll let her know,” Robert says, thinking of Sally’s surgeon Cindy Jacobs, her slightly befuddled gaze, her sturdy, competent hands. Sally has the best surgeon she could possibly have, and Robert wonders if Sally knows that. “She’s a wonderful surgeon, and we’ll talk more extensively after your surgery.”

Mia stands up, and Robert’s heart begins to speed up, a trill of adrenaline along his sternum.

“I’m going to go to the waiting room,” she says, picking up her jacket. “You don’t need me for this.”

She smiles at her mother and then turns to Robert. Her eyes are—yes, they’re amber, caramel, the color of the taste in his mouth.

“Thank you, Dr. Groszmann,” she says and then she opens the door, walks out, and closes it softly behind her.

Sally sits up and unties the front of her gown, turning her head away to look at the wall. “She’s a writer, you know.”

Robert slides his chair closer to her, pulling his tape measure from his right pocket. “Really? What does she write?”

“Novels. She’s in the paper all the time. Once she was on
Good Morning, America
.” Sally’s pulse beats so fast in the hollow of her neck, Robert wants to put his index finger there to calm her. Instead, he focuses on his tape measure, collarbone to nipple, nipple to nipple. Aureole dimension, chest wall, clavicle.

He rolls up his measure and puts it back in his pocket, pushing back toward the sink in his chair and washing his hands. “Can I get your daughter’s books at any book store?”

Sally pulls her gown tight around her. “Oh, yes. Amazon dot com. Barnes and Noble. Borders. She lives in Monte Veda and the bookstore there has her on constant display. Home girl makes good and all. But her stories are more—well, they might be geared more for women.”

So am I
, Robert wants to say, but doesn’t. He is geared for women but only temporarily, for short quick bursts and then he’s alone with his cat.

He moves away from the sink and looks at Sally Tillier. “You’ve thought about the type and stages of reconstruction?”

Sally nods. “What about that TRAM flap thingy?”

Robert shakes his head. “It won’t work for you. You’re too thin. Not enough material to work with.”

Opening her mouth, Sally looks up at him, but then whatever words she had disappear. She shrugs. “Well, maybe by the time we do this, silicon will be back. Those breasts looked a bit more, well, real. I guess they feel more real, too.”

“Some people think so.”

He stands up and throws the paper towel in the garbage. “Sally, it’s been a pleasure. I think you will be very happy with your choice. We will be in touch in a few months. I wish you the best with your surgery and treatment.”

Robert takes her hand, shakes it, feeling her nerves and blood tingling in her palm.

“Thank you, doctor,” she says. “You’ve been very helpful.”

Robert smiles and then leaves the office, Sally’s chart held tight against his chest. The moment he’s out in the hall, Carla comes over to him, notes in her hand, messages from five patients (Jackie Lagalante already?), a consult needed in dermatology and the ER, stat, messages from Drs. Jacobs, Sengupta, Cho, Walters. And in no time at all, Sally Tillier and Mia Alden leave his mind, cancer and novels and all.

“Rob, listen. You’re not seeing the big picture,” Jack Slater says, sitting back in the booth at Primo. Robert has known Jack since their first year of college at Berkeley, back when Jack was skinny and acne prone. Now, thanks to Accutane and Club Sport Athletic Club, he’s the joy of all his female patients.

They’ve finished a very late dinner, and are now drinking brandy. Jack used to work for Inland where Robert works still, but has since moved on to a private practice, seeing patients in a large, royal suite of offices in Alamo, an expensive bedroom community.

“What picture would that be?” Robert is used to Jack’s largesse after a huge meal, his expansive discussion, his sweeping comments, his need to try to understand Robert. Jack always wants to talk about big ideas, turning each and every conversation into proof of how Jack has lived his life one hundred percent right and how all Robert has to do is hurry and catch up.

“Our work. It’s art. It’s the intersection of art and science. How people look reflects how they feel inside. If you change their appearance, you can change their soul.”

“Oh, Christ. Jack! Do you hear yourself? If you feel that way, you have a demented God complex. If you want to do art, go get a potter’s wheel. What we do is about helping people.”

Jack sips his drink, smiling. “Helping them do what? Feel better about themselves?”

“Yeah.”

“So if they feel better about themselves, doesn’t that affect their psyches, their souls?”

Robert pushes his hair back and shakes his head. “If I reattach someone’s finger, don’t you think that person will be better about himself than he did the moment the jigsaw cut it off?”

“Maybe. But he’s only had his finger off for, what? An hour tops? A woman with a big nose or huge jaw will have had that since birth. Her whole personality has been formed based on the fact of this defect. She’ll have learned to hide it. She’ll have endured teasing. Think what’s been affected? Her self-esteem, self-love, self-value. She will have found ways to relate to lovers based on it. Rightly or not, her parents may have even treated her differently because of it. So when I do a rhinoplasty, I can take away her need to hide, to fear, to loathe. I lift that dark shroud off her personality. I change her.”