Grow Old Along With Me
Rosalind Kaplan
Grow old along with me
The best is yet to be
When our time has come
We will be as one
—Robert Browning
It’s 6:45 p.m. and I pace in front of the bedroom window, gazing down the street every couple of minutes. Here comes Larry, finally, around the curve of the road, bike pedals slowing as he turns and coasts up the driveway. I exhale, and head down the stairs.
He meets me in the kitchen.
“Hi! How’s your day been?” he asks. Casual, carefree. The cleats from his bike shoes click on the stone tile floor. Clad in spandex from neck to knees, a colorful bike jersey, one of the many in his collection, over a unitard he calls “bib shorts,” he stands near the counter, dripping with sweat. The LED headlamp attached to his helmet remains on, glaring directly into my eyes. I clench my teeth.
“Good,” I reply. “How was yours?”
Our evening will proceed. Larry will shower and change, and we will make dinner together, standing at the granite counter, Larry chopping vegetables for our stir-fry while I sauté garlic and sear chicken. Our little mixed-breed rescue dog will beg for tastes of human food. Larry and I will chat about our respective days. We won’t talk about my pacing or my clenched teeth. I have taken a vow of silence regarding his bicycle commuting.
Larry started biking to work in 2006. He’d been complaining for years about how stressful it was to drive to work each day, fighting what constantly seemed like rush hour traffic, even though, as a hospital-based physician, he left the house by 7 a.m. and often didn’t return until after 6 p.m. After seeing Al Gore’s documentary, An Inconvenient Truth, Larry told me, “That’s it. I’m not driving to work anymore. I’ll bike commute every day. I’ll do my part for the environment and get my exercise that way.” Larry is a man of great resolve. He doesn’t make such declarations lightly.
Never mind that for more than half the year, he is either coming or going in the dark. Never mind that his commute takes him on busy streets and through part of North Philadelphia known as the “badlands” because of drug- and gang-related crime. Belmont Plateau, an area he rides through daily, is known as a place where drug dealers peddle their wares, and there are nearly daily shootings in the blocks around Temple Hospital and Medical School, where Larry works. Still, the only thing that stops him from riding his bike to work is heavy snow or ice.
Our friends tell him he is going to get hit by a car and die. Our friend Mark, who stopped riding a bike in the city years ago after seeing a cyclist get hit by a car, asks every time we see him if Larry has given up bike commuting yet.
“No, I love my bike commute,” Larry replies serenely.
“Seriously, Larry,” Mark replies, “you should think again. It’s not a matter of ‘if’ you get hit, but ‘when.’”
“I’ve been riding for years, and I’m fine. I’m not going to get hit,” says Larry with authority.
It doesn’t matter that one of my medical school professors died in such an accident twenty years ago, or that, more recently, a friend who was inspired by Larry’s determination to start riding his bike to work was hit by an SUV and had to be airlifted to a trauma center on his very first bicycle commute.
There have been near misses: the truck that blew through a stop sign just when Larry was crossing the off-ramp to the expressway (Larry saw it coming and leaped off his bike, which was mangled, though he escaped with just bruises) and a tire caught in trolley track (Larry will tell you his broken scapula was a minor problem and that, again, the bike fared worse than he did). He often comes home with cuts and scrapes from “little falls.”
Always pragmatic, Larry cites studies: “According to the CDC, the odds of dying in a car accident far outweigh the odds of dying in a bicycle accident,” he informs me.
If one looks strictly at risk data, this, in fact, is true. The “lifetime odds” of dying in a car crash in the US are 1 in 303. The “lifetime odds” of dying in a cycling accident in the US are 1 in 4,717. But I refute this data. It looks like cycling is far safer than driving, but to compare these odds makes the assumption that as many people ride bicycles as drive cars. It also does not take into account that many cycling trips occur on trails without cars or on quiet streets, while Larry’s cycle commuting takes him on major roads, greatly increasing the chance of a serious accident. In truth, we can’t calculate his specific risks. Our positions are heavily weighted with emotion.
Larry believes that his safety equipment and the light-reflecting strips on his spandex, along with his superior skills as a bicycle commuter, will prevent a serious accident. And perhaps he’s right. Helmets and lights and vigilance reduce risk. Experience means he’s less likely to make a dangerous error in judgment. Still, I can’t stop worrying.
Six or seven years ago, after he fell off his bicycle and walked into the house with bloody abrasions over both knees, he told me he’d go back to driving if I adamantly opposed bike commuting. He sat on the edge of the white tub in our master bath while I dabbed at his wounds with a wet washcloth, trying to remove the last bits of gravel from his torn skin.
“I hate that it upsets you,” he said, “but I hope you can live with it, because it makes me happy.”
How could I veto an activity that brings my husband joy?
Instead, we struck a bargain. He would wear a cyclist’s bracelet with his name and emergency contact information engraved in it. He would text me when he gets to work, and again when he’s about to leave work to head home. If something happens to him, I will know. He won’t be left, broken and bleeding, his bicycle frame mangled, on the side of a road. In return, I promised to refrain from constantly reminding him of the risk he is taking, or of my anxiety about said risk.
This “compromise” is tenuous. Neither of us is completely satisfied. He finds himself having to “check in” like an errant teenager. I am full of silent reproach, ever the disapproving parent. I channel the histrionic home-bound woman, flinging herself at the cool, detached lover leaving for an adventure. We rehearse and perfect our parts, the unwilling actors in a play about stereotypical gender roles.
My fear is an embarrassment, my caution a proof of failure at my own quest, because, in my own life, I believe myself to be bold and irrepressible. I’m not a delicate flower; I can pitch a tent and build a fire, and I’ve had my share of scrapes and bruises from the great outdoors. I’m also no stranger to inner city strife. I’ve lived and worked in all manner of urban neighborhoods. In my years as a physician, I’ve encountered guns in the ER, switchblades in medical clinics, and plenty of patients who were angry or just plain belligerent.
I feel burned by the anxiety I have now; an ounce of denial would be a soothing salve. I’ve tried to develop denial, grow it like cells in a culture medium, exercise it as a muscle I can strengthen, but my cells refuse to divide. The muscle remains flaccid.
I remind myself that all risk is relative. To live is to take the risk of dying over and over each day. We each make judgments about the risk and benefit of every activity we undertake. We make constant, specific, but usually unspoken declarations about which actions are worth the risk posed by them. We make general, also usually unspoken declarations about the amount of risk we each will tolerate. I will hike in the wilderness, ski downhill on the black diamonds, raft on whitewater. I love the periodic adrenaline rush of slightly risky physical activity, which makes my objection to Larry’s cycling seem all the more irrational. I am inconsistent and contradictory. Perhaps these activities feel safer because we usually ski and hike and raft together or in groups, while Larry’s cycle-commuting is done alone. I have no way to know if he is safe, so my imagination is free to roam, unchecked, through the possible accidents he could have. Beyond that, I think it’s the daily repetition that wears me down.
Our friend Bruce, a recreational thrill-seeker, argues that the more risk we take, the more alive we actually are. I won’t go that far. I don’t want to be dropped out of an airplane or try to climb Everest (two activities Bruce aspires to), but I also don’t want fear to dictate everything I do.
Larry and I have been married thirty years. I don’t think of us as old, not yet. Larry has just passed sixty; I am heading directly toward it. We are still energetic and active, though the early signs of decrepitude are creeping up on us—aches and pains, the need for ibuprofen a couple of times a week. Actuarial tables estimate that Larry will live another twenty-two years, and I will live another twenty-seven. Studies on happiness and aging say that, on average, Americans are happiest with their lives in the second half of their seventies. The best part of our lives is, perhaps, yet to come. That is, unless an unexpected cause of early death strikes one of us.
Larry says he doesn’t often think about the potential for premature death. He makes the assumption, over and over, that it won’t happen. I, on the other hand, touch base with my fear of it at least a few times a day. The cycling. A car accident, especially in inclement weather. Sudden onset of illness. Sudden cardiac death, though neither of us is at increased risk for it. One or both of us could be struck down by any of these scenarios at any time. I don’t dwell on that or worry about it at length; the knowledge of it just lurks on the edge of my consciousness.
We are both physicians, similarly trained, but even that seems to have affected us differently in this regard. Bodies, human bodies, are magnificent and miraculous in all that they can do. They are amazingly resilient, fending off invading pathogens, healing in the face of horrific damage. Larry always thinks about the resilience, clings to it.
“Most of the illnesses we see are self-limiting,” he declares, when we talk about our work. True enough.
But bodies are also just a conglomeration of cells, and the cells can wear down or wear out or go awry. They can destroy and be destroyed. This is what I see, and I watch for signs that we are at the beginning of some sort of destruction.
Is one way of being “better” than the other? Is one of us “right” and the other “wrong”? Sometimes it seems that having more denial would allow me to live more serenely in the world, to suffer less, especially since so many risks are either unavoidable or so subjective in their magnitude that I can’t judge if my trepidation is reasonable. But how much denial is optimal? When does it become dangerous, a flirtation with peril? Neuroscience tells us that fear is hardwired in the limbic system, an ancient part of the brain, and that the fear response is not only normal, but necessary to protect oneself from danger. When is it a good thing for denial to tamp down fear, and when does it become a liability? The answer is obvious if I am being attacked by a tiger and equally obvious if I am being attacked by a gnat. But what about the gray zone in between? Isn’t most of life somewhere in between?
What happened on Thanksgiving five years ago was an instance of dangerous denial. Larry fell ill with a fever and malaise the Monday before Thanksgiving. He powered through his workday, a tactic familiar to most doctors, as we tend to be workaholics and to feel we must put our patients first, even when we’re sick. On Tuesday, he went to work but left early after spiking a high temperature and developing shaking chills. I came home to find him sitting in the overstuffed chair in the corner of our bedroom, wrapped in a blanket and popping TUMS.
“What’s going on?” I ask. “You said you felt okay when you left for work this morning.”
“I have the flu,” he replies. “I’ll be fine.”
“Your office mates said you had shaking chills,” I inform him. “And what’s with the TUMS? Is your stomach upset?”
“Why are my colleagues calling you?” Larry asks, peeved.
“They’re your friends. Our friends. And they were worried about you, so they called me.”
“I’m FINE. I just need to be left alone. I took ibuprofen. I guess I took too much ibuprofen, because my stomach is a little upset from it, but I’m FINE. I just want to sleep,” he pleads.
Destruction, I think. This is not ordinary. This is not the flu. My intuition is working. Maybe it’s working overtime. I say nothing. Messing with Larry when he’s talking in capital letters means war.
He looks even worse the next day. At least he stays home from work.
“I think you should see a doctor,” I tell him.
“I am a doctor.” He is sitting in the chair again, shivering in a blanket. “I know it’s the flu. What is a doctor going to do for me? It would be a poor use of medical resources to go to a doctor.”
“You can’t diagnose yourself. You shouldn’t be your own doctor. And tomorrow is Thanksgiving, so if there’s really something wrong, you’ll end up in the ER.”
“I’ll be FINE by tomorrow. I’m getting better.” His tone is dangerous.
“You don’t look better.” Destruction.
He ignores me and waves me away. He sleeps and drinks fluids and takes ibuprofen. I try to believe him. I try not to believe my mounting worry.
That night, he soaks the sheets in sweat.
Drenching night sweats are a bad sign, says the undefended voice in my head.
“See, my fever is breaking,” says my husband.
Thanksgiving morning, his skin looks a bit gray, but he says he feels much better. He says he is FINE. We go to his sister’s house, just a mile away, for Thanksgiving. Their parents and another sibling and all of our young adult children are there. Larry sleeps in the den most of the day.
“What’s wrong with Larry? He looks terrible,” says his father, Al, a retired family doctor. He is sitting in an armchair in my sister-in-law’s living room, wearing his retirement uniform of stiff blue jeans and a plaid flannel shirt. His glasses are slightly askew as he ruffles through a newspaper.
“I don’t know. He says it’s the end of the flu, and he won’t get care. I’m concerned,” I say, hoping for some help.
Al just shrugs.
“I’m sure he’ll be fine,” he says.
I forgot that he is the original King of Denial.
At dinner, the long table is overflowing with platters of turkey and brisket, bowls of mashed potatoes and cranberry sauce, tureens of roasted vegetables, gravy boats and ladles. Larry only eats a pecan. Just one pecan. Nobody else seems to notice. Everyone is talking at once at the table, passing plates of food, sipping wine, thinking about the pies and the chocolate peanut butter cake lining the kitchen counters, waiting for their turn.
The pecan is my call to action. I am done with the charade. As the kids clear the table and the adults head for the living room, I rummage in my sister-in-law’s medicine cabinet for a thermometer and ambush Larry in the hall. His temperature is 103.5.
“It’s time to go to the ER,” I tell him. “You are sick. If you don’t get in the car and go, I’m going to divorce you. This is the most foolish behavior I’ve ever seen from you. Either you go, or I’m going to leave here without you, and tell the kids not to bring you home. Your family of origin can deal with your bullshit. And you know how they’ll deal with it? They’ll ignore you, and you’ll die on the floor, and they’ll just step right over you.”
“Okay, okay. Fine. But my dad wants a family picture, so let’s do that first.”
“Are you serious? We have to do a family picture when you have a 103.5 temperature?”
“Yes.”
“Fuck, you are crazy.”
We leave the bathroom to find the family lining up for the yearly Thanksgiving photo.
“Oh, there you are,” says Larry’s dad. “Roz, get in back. Larry, sit down in front with the guys.”
The King of Denial snaps the picture. I see Larry wincing as he rises. He’s got an acute abdomen. He’s going to need surgery, the undefended voice in my head tells me. I make excuses to his family, tell my kids half the truth, and push him out the door.
“This is a very poor use of medical resources,” Larry tells me, as I half carry him to the car for the ten-minute trip to the ER.
“Yes, you said something about that yesterday. If you wanted to make better use of resources, you would have seen a doctor days ago,” I reply in as neutral a tone as I can muster.
At the ER, he is sent immediately to CT scan. He has diverticulitis, an illness that is often mild and managed with antibiotics. But Larry’s diverticulitis is much more severe; his colon has ruptured and he has peritonitis. In fact, the rupture likely occurred three days ago, when he had shaking chills.
Because of his otherwise excellent health, he escapes immediate surgery, which would have included a temporary colostomy, and is admitted for intravenous fluids and antibiotics. The first forty-eight hours are touch-and-go, the surgeon ready to intervene at any moment if Larry doesn’t rally. He spends this time in a unit just one step down from Intensive Care, attached to a heart monitor, in and out of a morphine-laced sleep.
As I wandered the hushed hallways in the hospital during those initial two days, I reviewed the events of Larry’s illness in my mind. Why hadn’t I been more assertive?
I hadn’t pushed harder because I’d doubted my own perceptions. I would not have done this with a patient; in my clinic I am dispassionate, clear-headed. I know who is sick and who is not. I triage and treat, convey caution to the cavalier, calm the fears of the overanxious. Nor would I have doubted myself with my children, for whom my intuition is so well honed that it approaches prescience. But my husband’s confidence was such that I lost my own. His denial dictated our actions, to his detriment. Now he might end up with a colostomy. Now, he could die.
I’ll kill you if you die, I thought. I was angry at him for lying in a bed, floating on morphine, leaving me to handle this alone. I was angry at myself for listening to him when he said he was FINE, but I knew he wasn’t. I was just angry. We’re supposed to grow old together.
“I’m going to listen to you in the future,” Larry told me, once he recovered.
“Maybe it’s not listening to me,” I replied. “Maybe it’s just paying attention to what your body is telling you. Maybe it’s not trying to be such a hero all the time.”
“You’re right,” he ceded quietly.
In the past, I would have been thrilled to hear that I was right. But now that “rightness” was a hollow victory. I didn’t want to be right. I didn’t want Larry to be wrong. I wanted to believe that we could make the right decisions to keep ourselves alive.
Before 1990, I might have acted just like Larry did in the first days of his illness. I turned thirty in 1990. I had my first child in 1990. Neither of those events would have, alone, changed my mindset, but other things happened that did.
In my young life, before age thirty, I had already been through a series of medical issues: meningitis at age four, an episode of arthritis possibly portending an autoimmune disease at age sixteen, a hospitalization for an eye infection that threatened my cornea at age twenty, a yearlong bout of colitis in my mid-twenties, and chronic migraines (shared with my mother) since age ten. My father became extremely protective of my health from the time of the meningitis, keeping me home from school for sniffles and whipping out a bottle of a bitter elixir called terpin hydrate if I coughed even once, trying to talk me out of any activity that might result in injury. I know I caused him endless worry. But I was young and reckless, and the more he fussed over me, the more determined I was not to be sick.
I bucked against any kind of physical limitations. I ignored warnings and believed I was invincible. I proved my invincibility to myself by skiing and skating, hiking in the wilderness, and experimenting with pot and alcohol as a teen. I thought I’d proved it to everyone else by getting through medical school and a rigorous residency during which sleep deprivation and forty-hour work shifts were the norm.
By the end of residency, I was not only still alive, but, inexplicably, I was well, save an occasional migraine. And I was a doctor, married and pregnant with my first child. Denial had apparently worked in my favor.
Max was born in September of 1990. My pregnancy had been smooth and easy. I thought I had life under control. But Max turned blue in the newborn nursery, and was transferred to Newborn Intensive Care. Unable to find a cause, the neonatologists sent him home on an apnea monitor. It could happen again, they said. It could be related to sudden infant death syndrome. Deeply shaken, I tried to return to “normal” life, but suddenly the world was not a safe place.
The apnea monitor alarm went off now and then, and we would run, panicked, to Max’s crib. Each time, we found him not just breathing, but pink and awake and moving.
After a few months, the pediatrician took the monitor away.
“I knew there was nothing wrong with him,” Larry told me. I knew no such thing. I didn’t reply.
We’d been without the apnea monitor just a few weeks when my mother died suddenly at the age of sixty-two. She’d most likely had a massive stroke. But there’d been no indication that she was ill. Now I was certain that life was terrifying and capricious.
Soon after my mother’s death, I had some routine blood tests, and my liver function tests were abnormal. A workup revealed that I had chronic hepatitis C, a bloodborne viral disease I almost certainly contracted as a health-care worker in a high-risk urban hospital. I had no symptoms, and there was no immediate threat. The problem with hep C is that, over a period of years, it causes progressive liver damage, and can lead to liver failure or cancer in some (but not all) patients. Because research around hep C was in its infancy at that time, early in the 1990s, the only treatment available was an experimental protocol that was known to have unpleasant side effects. The chance of cure with it was only 25 percent. My prognosis without treatment was a complete unknown, and it wasn’t much better with treatment. Any remaining denial of life’s cruel randomness was pried loose from me by this information.
I felt abandoned and lost when Larry continued to court optimism.
“You’re going to be fine,” he told me as he sat in a vinyl chair next to the hospital bed where I waited for the doctor to perform my first liver biopsy. “We’ll get through this, and you’ll get treated.”
We were in a gloomy old wing of the Hospital of the University of Pennsylvania. The pale green walls were scuffed and the cracks in the paint made me think of veins, which led my mind right back to my liver.
“No, I’ll get through this,” I retorted bitterly. “And we don’t know if I’m going to be fine. The treatment is toxic and has very little chance of working.”
“If it doesn’t work, there will be something else.”
“If I don’t die first.”
In retrospect, it’s a good thing one of us still had some denial. We had a child. We had careers. We had a life together. There was no option but to keep moving forward and to fight. I’m not sure I could have done that without Larry’s belief in a good outcome. But that didn’t keep me from resenting it. It didn’t seem fair that he could still go through life with equanimity when I couldn’t. It was only much later that I realized how hard he worked to push back his fear so there would be room for mine.
As it turned out, he was right, at least in the long term. I completed two unsuccessful trials of experimental medication before an improved protocol, with a slightly higher response rate, cured me, in 1998. Ultimately, Larry’s assessment that, even if there was no answer for hepatitis C twenty years ago, there eventually would be one, has even come to pass, as drugs with cure rates close to 98 percent became available by 2014.
Despite the good fortune of my cure, I wasn’t able to recover my capacity for denial. The universe continued to seem chaotic and random. I also developed an impatience for pragmatism. Data, useful for taking care of patients, no longer applied to my own life. After all, Max’s breathing problem and my mother’s death remained largely unexplained. My mother’s risk of sudden death as a seemingly healthy sixty-two-year-old had been remote, if you looked at statistics. My risk of hepatitis C was probably less than 2 percent. On the flip side, the experimental protocol should not have cured my hepatitis, either, yet I was cured. What was I to make of all this?
Without the comfort of evidence or the bliss of denial, I had no framework to rely on. I’d never believed in a personal God, so I didn’t have prayer. I sometimes resorted to magical thinking: We’ve been through a string of negative events. We’re due for a period of peace. Other times, I had to rely on my intuition, but I wasn’t sure I could trust it. At some moments, I just assumed the worst and hoped for the best, an unhappily skewed form of fatalism I manufactured to prevent false hope. I think the distress this engendered in me led Larry to try to protect me when there were things I might not need to know.
The first time he kept medical information from me, it was about Max. By the time he left for college, our curly-haired, blue-eyed son had become a serious student-athlete. Though prone to sarcastic jokes and witty wordplay, he was a pretty level-headed young man. In his sophomore year at Wesleyan University, Max sustained a significant concussion during a wrestling match. He called home after the trainer had taken him for a neurologic evaluation and a CT scan of his head. Only Larry was home, and he suggested to Max that they keep this information to themselves. I imagine Larry didn’t want to worry me. Max might have been afraid I’d push him to stop wrestling as I’d always been concerned about the risk of head injuries.
Fortunately or unfortunately, he was due to come home for Thanksgiving less than a week after the head injury occurred. He arrived the Wednesday afternoon before Thanksgiving, while I was still at work.
When I got home, Max came to the front door to greet me. Larry was already home, standing in the hall behind him.
“Hi, Mom,” Max said, leaning in for a hug. But I’d already seen his face, and something wasn’t right. His eyes were bloodshot. He had a dazed, glazed-over look. I grabbed his shoulders and held him away from me to peer at him.
“Max, what’s wrong with you? Are you drunk?” I asked him, alarmed. I saw Larry tense.
“Dad,” Max said to Larry, “I guess we have to tell her.”
Fortunately, Max’s brain healed over a short period of time. He returned to school after Thanksgiving weekend and to wrestling a few weeks later. Eventually, after another injury, he made his own decision to quit the sport.
I was furious at Larry for keeping the concussion a secret and laid into him.
“He’s my son as well as yours. What gives you the right to play God? And what made you think I couldn’t handle it? I’ve never given you any indication, in all these years of parenting, that I would be irrational or alarmist about injuries. All through high school, I’ve handled both kids’ medical care, taken them to the doctor, to tests, to the ER…sometimes without you when you weren’t around.”
“But I thought…” Larry began, but I interrupted before he could finish his sentence.
“Never do this again. What if there’d been complications to this concussion and you’d never told me it happened in the first place?”
I was hard on him. Especially since I knew, even then, that he’d meant well. I hadn’t needed protection; a concussion seemed pretty routine to me. But Larry had seen me at my worst moments. He wasn’t sure what to expect. Besides, he had grown up with the King of Denial as a role model.
When Larry’s mother was in her early forties, she developed thyroid cancer. His father conspired with her doctor, his colleague, to tell her only what she needed to know: that she had a lump on her thyroid, and it needed to be removed. The word cancer was never spoken. Later, he told Larry and their other three children that the “lump” was malignant, as they needed this information to manage their own medical care, but he swore them all to secrecy. Larry’s mother is now eighty-eight years old, and she still has no idea she had cancer.
This kind of medical paternalism was common forty-five years ago, but is no longer considered acceptable. I don’t know how Larry’s mom would have reacted to a cancer diagnosis, but I think she had the right to know. I suspect she would have handled it with spirit. She’s never been the fragile type. In all the time I’ve known her, she’s been as tough as an unmarinated flank steak.
Larry apologized for trying to cover up Max’s head injury, but he might have done it over again, given my unpredictable reactions to bad news. Even twenty years out from 1990, the worst year of my life, my coping was precarious. When our daughter was diagnosed with celiac disease as a teenager, I handled it with competency and grace, making sure she had the right foods and enough instruction on avoiding wheat to manage herself when she moved away for school. The same year, however, I fell apart after I had a minor car accident, weeping on and off for days, and afraid to drive until my sister-in-law insisted I get behind the wheel and drive her around the block. One of our kids calling from college with a romantic problem might keep me up all night, but I took it in stride when Larry tore the cartilage in his knee and needed surgery.
I couldn’t explain it then, but now I see it clearly. If a problem, even a big problem, had a solution, I was fine. I took charge. I did what needed to be done. What knocked me down was uncertainty and lack of control. My failure to recognize this and explain it to Larry contributed to our communication problems.
The most recent gaffe occurred only a few months ago. During a workup for some vague dizziness, Larry’s ENT doctor ordered an MRI of his brain. I initially wasn’t concerned. My own medical knowledge told me that his symptoms were related to the inner ear and not the brain, and that his doctor was just covering all her bases. Larry had the same belief, and scheduled the scan a week or so later. By then, his symptoms were long gone, but he followed through to be complete.
The morning of the MRI, though, I started to feel anxious. What if we were wrong, and this was the beginning of some sort of destruction? A malignant brain tumor or an aneurysm about to rupture?
“Call me with the results of your scan as soon as you have them, please?” I pleaded with Larry. I knew he could have results by 10 a.m. or noon at the latest, since he was having the MRI at the hospital where he’d worked for almost twenty years, and where he knew all the radiology staff and radiologists.
“I will, but it’s going to be normal,” he replied.
I was working at home, doing some medical editing. A little after noon, realizing I hadn’t heard from Larry, I got up from my desk, went to the kitchen, and dialed his number.
“Hey, what’s up?” he said, as though this were a normal day. It might have been, if we knew the scan was negative.
“Did you get the MRI results yet?” I asked, as I scooped some yogurt into a bowl.
There was a beat of pause. One beat too many.
“No, it’s not read yet.”
“Are you sure? Maybe you should check with the neuro-radiologist.” I wanted to believe him, but I felt like something wasn’t right.
“If I don’t hear by the end of the day, I’ll call. I don’t want to annoy anyone,” he replied.
Uneasy, I returned to my desk. I changed some wording in the paper I was reviewing, looked up a citation to check accuracy. The document was about a disastrous blood disorder called aplastic anemia. No wonder I worry, reading this kind of stuff, I thought. I tried not to think about brain tumors. I tried to ignore the rising panic in my chest as the afternoon wore on.
At 4 p.m., I still hadn’t heard from Larry, and was about to call him again when I heard the kitchen door open. My heart began racing. Larry never comes home from work before six.
He popped his head into the study. He looked fine, despite his sweaty spandex bike outfit.
“I’m going to take a shower and change,” he told me. He sounded normal. Too normal.
“Wait! Aren’t you going to tell me about your MRI? I’ve been worried all day!”
He hesitated a moment. Destruction. I held my breath. Then he produced a small pile of papers from his bike pannier.
“Here’s the report. I have a schwannoma on my ninth cranial nerve. It’s very small. I’m waiting for a call back from someone from neurosurgery to find out what I have to do.”
A schwannoma is a benign tumor made up of glial (Greek for glue) cells, which surround nerves to protect and bring nourishment to them. The ninth cranial nerve exits the brain at the base and innervates parts of the tongue and throat.
The medical knowledge Larry and I have in common was an immediate shortcut. I knew instantly that he wasn’t going to die from a brain tumor or an aneurysm. I knew that this benign mass would not grow quickly or invade brain tissue, curling around the normal cells like the tendrils of an invasive vine. I knew that it would not metastasize to distant organs. This schwannoma was not even responsible for Larry’s dizziness.
I didn’t know exactly what would need to happen next. Even a small, benign mass is not a good thing. Any space-occupying intracranial lesion is not a good thing. It could grow and press on adjacent nerves or on brain tissue. Any growth would need to be limited or stopped. In its current form, it might not need any treatment, and if it grew, there were options. Of course I was concerned, but mostly I was relieved. Still, what I unleashed on my husband was anger.
“You knew this when I called you at noon, didn’t you?” I asked, narrowing my eyes.
“Yes, but I didn’t want to tell you over the phone. I was worried you’d be upset.”
“I am upset. But not about the freaking schwannoma! I’m upset that you lied to me. I’m upset that you didn’t trust me to handle this! I was terrified all day that you had a malignant brain tumor. And now I’m upset that you rode your bicycle home when you have a tumor in your head! You don’t even know what you need to do yet. You haven’t talked to your doctor, have you?”
I heard myself screeching. I knew I was being irrational.
Larry stood quietly waiting for me to finish. Instead I burst into tears. Larry put his arms around me and let me cry into his spandex.
“I’m so sorry,” Larry said. “I didn’t realize you were worried all day! I thought it would be better not to tell you on the phone so you could look at the report and the papers I printed out on schwannomas. I was hoping I would have a definitive plan as to what to do before I told you, but that didn’t happen.”
“No, I’m sorry!” I sobbed. “I don’t know why I’m yelling. I just knew all day that you were keeping something from me and it scared me. You’re a terrible liar! And you don’t need to know the plan. I can help with that, help you set up appointments with the right people. But for now, I didn’t even ask if you were okay!”
“I’m okay. I’m not upset about it. I’ll do whatever I have to do about it. I did talk to my doctor, but she’s an ENT, and this isn’t even what caused my dizziness. This was just an incidental finding, and she doesn’t know what to do about it. That’s why I called one of the neurosurgeons. Of course we’ll ultimately figure out the plan together.”
I finally stopped crying. It was going to be fine. No destruction, at least not from the schwannoma, and not at that moment.
Later, I contemplated my reaction. Did I have any right to expect Larry to tell me his scan results as soon as he got them? Wasn’t it his right to decide when and how to tell me? Wasn’t it his tumor? And yet, once another person is so inextricably bound up in your life, any problem, any crisis, belongs to both of you. The problem is no longer only about you, nor is the solution. I think he should have told me, but he didn’t because he wasn’t sure I’d react rationally. It gave him cause to infantilize and control me, like his father did to his mother when she had thyroid cancer. This was exactly what I didn’t want. I would have to be clear about what I could handle if I wanted him to share information.
A week later, we sat in an exam room at the radiation oncology department at the University of Pennsylvania with a neuro-radiation oncologist, Dr. C., reviewing Larry’s scan. She pointed to a medium gray, dumbbell-shaped blob superimposed on several other shades of gray.
“So there it is. It’s very small. And you can see it’s not pressing on any brain tissue or any of the other cranial nerves.” We peered at the blob and the sea of slightly darker gray representing cerebrospinal fluid surrounding it.
“If this grows larger and starts to impinge on other structures, we can destroy it with a single dose of radiation—that’s called Gamma Knife treatment. It’s very precise. The risk of damaging the nerve is about one percent—very low. The risk of other side effects is even lower. But right now, I’d suggest we just monitor this. Get another scan in three months. If it hasn’t grown, we can leave it alone.”
I saw the crease in Larry’s forehead relax, the edges of his mouth curl up.
“Dr. C., I just have one more question,” Larry said. “Is there any reason I can’t ride my bicycle with this schwannoma?” He was grinning at this point. Teasing me.
Of course the answer was “no.”
“I still hate your bike commute,” I tell Larry as he leaves for work in his spandex unitard and cleats. I haven’t told him that part of what I hate is the spandex. It’s not a great look on a man of a certain age.
“I know and I’m sorry. I really don’t want to give it up, though. I need it. I really am careful. I know it’s not just about me,” he replies. “I promise I’ll quit if I start being klutzy as I get older.”
“I don’t like it, but I’m okay with it. It’s not like you’re sky-diving every day. I want you to be happy. I believe you that you’re careful.”
I know now that what I really hate is that I have no control over what happens. I can’t make drivers want to share the road. I can’t stop people from speeding or texting while they drive. But controlling my husband is not the answer.
I can’t trust the world to be a safe or kind or fair place, but it’s the only world we have. Ultimately, Larry and I want the same thing: we want to grow old together, and we also want to live our lives, to feel alive, for however long we are here.
Rosalind Kaplan has been published in several literary and medical journals, including Amarillo Bay, Annals of Internal Medicine, Another Chicago Magazine, Brandeis Magazine, Eastern Iowa Review, HerSTRY, Minerva Rising, Prompted, a Philadelphia Stories Anthology, The Pulse Magazine, The Smart Set, and Stonecoast Review. She is a physician and also teaches narrative medicine and medical memoir writing at Thomas Jefferson University/Sidney Kimmel Medical College. Dr. Kaplan is a 2020 graduate of Lesley University’s MFA in creative nonfiction, and she has attended a number of writing workshops. She lives with her husband and a rescue dog, and has two grown children.