Maybe You Should Talk to Someon - Lori Gottlieb Page 0,106
Julie and Matt came up with a new plan, as they’d had to do so many times since the beginning of their marriage. She would get her fibroid removed and attempt one more pregnancy. If that didn’t work out, they’d ask Emma to carry their baby. And if that didn’t work out, they’d try to become parents through adoption.
“At least I don’t have cancer,” Julie had said in my office after she finished explaining the baby setback and the plan forward. Except that while preparing for her fibroid removal, Julie’s doctors discovered the fibroid wasn’t the only issue. Her cancer was back, and spreading. There was nothing they could do. No more miracle drugs. If she wanted, they would do what they could to prolong her life as long as possible, but she would have to give up a lot along the way.
She was going to have to figure out what she could live with—and without—and for how long.
When the doctors first presented this news, Julie and Matt, sitting side by side in vinyl chairs in a doctor’s office, burst out laughing. They laughed at the earnest gynecologist, and then the next day they laughed at the solemn oncologist. By the end of the week, they had laughed at the gastroenterologist, the urologist, and the two surgeons they consulted for second opinions.
Even before they saw the doctors, they were giggling. Whenever the nurses, escorting them to an examination room, asked rhetorically, “How are you two today?” Julie would reply nonchalantly, “Well, I’m dying. And how are you?” The nurses never knew what to say.
She and Matt found this hilarious.
They laughed, too, when presented with the possibility of removing body parts where the cancer might grow most aggressively.
“We have no use for a uterus now,” Matt said casually while sitting with Julie in one doctor’s office. “Personally, I’d vote for keeping the vagina and losing the colon, but I’ll leave the colon and vagina up to her.”
“‘I’ll leave the colon and vagina up to her’!” Julie guffawed. “He’s so sweet, isn’t he?”
At another appointment, Julie said, “I don’t know, Doc. What’s the point of keeping my vagina if we remove my colon and I’ve got a bag of poop attached to my body? Not exactly an aphrodisiac.” Matt and Julie laughed then too.
The surgeon explained that he could create a vagina out of other tissue, and Julie burst out laughing again. “A custom vagina!” she said to Matt. “How about that?”
They laughed and laughed and laughed.
And then they cried. They cried as hard as they’d laughed.
When Julie told me this, I remembered how I had burst out laughing when Boyfriend said he didn’t want to live with a kid under his roof for another ten years. I remembered the patient who laughed hysterically when her beloved mother died, and another who laughed when he learned that his wife had multiple sclerosis. And then I remembered sobbing in Wendell’s office for entire sessions, the way my patients had and the way Julie had for the past few weeks.
This was grief: You laugh. You cry. Repeat.
“I’m leaning toward keeping my vagina but dumping the colon,” Julie says today, shrugging, as if we’re having a normal conversation. “I mean, I just got fake breasts. With a fake vagina, there won’t be much difference between me and a Barbie doll.”
She’s been figuring out how much has to be taken away before she’s no longer herself. What constitutes life even if you’re alive? I think about how people barely talk about this with their elderly parents, all the would-you-rathers that they’d rather not contemplate. Besides, it’s all a thought experiment until you’re there. What are your deal-breakers? When your mobility goes? When your mind does? How much mobility? How much cognition? Will it still be a deal-breaker when it actually happens?
Here were Julie’s deal-breakers: She’d rather die if she could no longer eat regular food or if the cancer spread to her brain and she couldn’t form coherent thoughts. She used to believe that she’d rather die if she had poop traveling through a hole in her abdomen, but now, she just worries about the colostomy bag.
“Matt’s going to be repulsed by this, isn’t he?”
The first time I saw a colostomy in medical school, I was surprised by how unobtrusive it was. There’s even a line of fashionable bag covers adorned with flowers, butterflies, peace signs, hearts, jewels. A lingerie designer dubbed them “Victoria’s Other Secret.”