Sepia

By Cora Schenberg

August 8, 2012. When I get scared, I lose my senses. I know that the walls of the clinic are acid green, but my eyes take in sepia.

“I’m glad you came in,” the doctor says. “Post-menopausal bleeding is never normal.”

Two weeks ago, my husband, son, and I were at the beach. I went into the bathroom to put on my bathing suit and found a spot of blood. I tried to ignore it. I figured the bleeding would stop by itself. When we got home and it hadn’t stopped, I called the clinic. The receptionist said my doctor was on vacation. Would I see Dr. A instead?

So here I am, bare-bottomed on crinkly paper.

“What do you think is wrong?” I ask the doctor.

“Unfortunately, I can’t tell anything from your exam. You’ll need to see a gynecologist. But I wouldn’t worry. It’s usually polyps or fibroids, which are benign.”

I had fibroids twenty years ago. Getting rid of them took major surgery and a six-week recovery. I don’t have time for this. I teach in the German Department at University of Virginia, and the semester starts in a few weeks.

Driving home from the clinic, I fall into a fantasy, where instead of undergoing a messy medical procedure, I can make time unspool, so the bleeding simply un-happens. I wouldn’t mind going back to April of this year, when our youngest nephew became bar mitzvah. The whole family was present and well. My husband Wade and I led the congregation in a favorite hymn. In a picture Wade’s sister sent, Wade, our son Gabriel, and I stand grouped around the bar mitzvah boy. Why can’t we step back into that picture?

But is that picture really where I want to end up? Gabriel, at seventeen, looks great, dwarfing all of us by at least a head and a half, his thick brown hair tousled, grin full of snark and confidence. But what about Gabriel’s parents? Mom’s got crow’s feet. Dad’s soft blue eyes show exhaustion; his once ginger hair has gone brown-grey. If we’re travelling in time, why not go back to when Wade and I met, in 1979? Or would it be better to return to October 16, 1983, when we said our vows before a rabbi? I remember how my hand turned radiant after Wade placed the ring on it. But then we didn’t have Gabriel. I wouldn’t want to live without him.

During my musing, I’ve been driving, and have now arrived at our house. I’m telling myself fantasizing won’t solve anything—besides, un-happen isn’t a word—when my teenager runs out, barefoot, to say that our friends the Smiths just called. “They’re coming for Shabbat dinner. Can you make lemon-ginger chicken?”

•••

Following Dr. A’s recommendation, I set up an appointment with my gynecologist. After examining me, Dr. B says, “I didn’t see any red flags in the exam, but let’s get you an ultrasound, to make sure you’re okay.”

A week later, she calls to say that the ultrasound tech “didn’t do a very good job,” so the picture is fuzzy. “However, it did show some fluid in the cul-de-sac between your uterus and rectum.”

“I’ve got a cul-de-sac? Like a dead-end street?”

The doctor laughs with me. But when I ask what caused the fluid, I hit a true dead end.

“I don’t know. But I’ve made you an appointment with a specialist, Dr. C. He’ll do the ultrasound himself, so there won’t be any problems.”

She gives me the date for Dr. C’s ultrasound: A month from now.

•••

The semester starts in a week. I feel exhausted all the time, and the bleeding is getting worse. I call Dr. D, my family doctor, to see if I’m anemic.

“Oh, I doubt dribbling for a month would make you lose much blood,” Dr. D says. “But sure, I’ll test your hemoglobin.” And a few minutes later, she reports, “Just as I thought—everything’s fine. And I see you’ve got an appointment with Dr. C. He’s the best.”

“But I have to wait another three weeks to see him.”

She smiles. “If he’s making you wait, it’s because he thinks your problem’s not serious.”

I’m fifty-five years old, but at this moment, I might as well be three. At the thought of contradicting the doctor, I picture myself as a pathetic, whining kid: but it hurts!

•••

The specialist, Dr. C, tells me I’m fine. “You’ve got a few fibroids, maybe a slight hormonal imbalance. But that’s not what’s making you bleed.”

“What is making me bleed, then?”

“We have to find out. I’m sure it’s nothing serious.”

Those words again. The doctor recommends a dilation and curettage, or D&C. “Very simple, a routine procedure.”

What planet have I landed on, where it’s “simple and routine” to be placed under total anesthesia while a doctor opens up and scrapes my uterus?

“My colleague, Dr. E, can do it,” Dr. C says.

•••

Sept. 16, 2012, a.k.a. Rosh Hashana, beginning of Jewish New Year 5773. At services, I stand between Wade and Gabriel. “Avinu Malkhenu, shema kolenu,” we chant. Our Father, our King, hear our prayer. A Hasidic legend tells us that on this day, the earth rises to the level of heaven. I imagine standing on tiptoes, whispering in God’s ear: “My doctors say I’m fine, but I don’t feel fine.” My belly aches and pulses. The holiday forces me to remember there’s no playing with time. We all petition God to inscribe us in the Book of Life for the coming year. But looking around, I see empty places where friends once sat. I wrap my prayer shawl around my shoulders and sink into the baritone voices of my husband and son.

•••

Dr. E’s office calls to say they’ve scheduled my dilation and curettage for September 26. I look at the calendar, see that day is Yom Kippur, and start to ask for a different date. But then I realize that since the surgery’s not until afternoon, I can attend most of the morning’s services. I write to the rabbi, explaining my situation. He writes back, promising prayers. And the Ritual Committee offers me an Aliyah—the chance to bless the Torah before the cantor reads from the scroll.

On Yom Kippur, I wake refreshed and energized, ready to pray the old melodies with lightness and joy that I’ve not felt in a long time. After the Torah reading, my family and I wave good-bye to the rabbi as we leave the sanctuary.

•••

Dr. E reports that my dilation and curettage was unusually difficult: “Your cervix was so tight, I hardly got any tissue at all. The good news is I’m pretty sure you don’t have cancer. But I’d like to do an endometrial biopsy to be certain.”

I agree to the biopsy; Dr. E. calls a week later.

“The tissue I got looks fine. You don’t have cancer.”

“You’re sure?”

“Positive. Malignant cells are very prominent. When I biopsy someone with cancer, all this brown stuff comes tumbling out.”

I shudder at the complacency with which she paints this horrid picture.

“What about the bleeding?” I ask.

“That’s a mystery. Honestly, Cora, we might never find out why you’re bleeding. Let me think about your case and get back to you.”

•••

As much as I like to play with time, I make an effort not to wish my life away. In college, we tended to live from one break to the next. We’d just gotten back from winter vacation when my freshman roommate Diana said, “It’s only two months till spring break!”

I did not tell her my thoughts: following spring break, it was only six weeks till summer, and from there, just four years till graduation, forty till retirement, and just a little while before we get to die.

Now, with the pain and bleeding, I can’t help wishing away work days. Teaching exhausts me. The only part of the day I enjoy is my bedtime ritual. It starts with a bath. The warm water uncramps my gut, washes away the blood. After the bath, I plug in my heating pad and lie down beside Wade. We hold each other and watch something innocuous on TV. Often, Gabriel joins us. I’ve gotten to love the Home and Garden Channel. People choose and buy houses. Sometimes they fix the houses up. No one is sick or in pain. Often, the houses are located in lovely places, like Hawaii.

•••

A week after my biopsy, Dr. E phones. “I’ve thought about your case. You have two options.”

Option 1 is a second D&C, this time using a camera called a hysteroscope, so the doctor can pinpoint the exact location of my problem and remove the cause.

“Option 2 is an ablation,” Dr. E tells me. “It means removing the lining of the uterus. Take a few days to decide which you prefer.”

I research the web and talk to Wade. In the end, I tell the doctor I choose the D&C, the less aggressive procedure. Why rip apart my uterus when I don’t know what’s causing the problem?

“But a D&C isn’t one of your choices,” the doctor says. “It didn’t work last time!”

“But you said you’d use a camera—”

“I don’t think so,” says Dr. E. “Your options are an ablation or a hysterectomy.”

My breath stops. Could I have gotten this wrong? Yet surely I’d remember if she’d said hysterectomy. The word sends a chill through my body. How can this doctor suggest removing my uterus or its lining without knowing what my problem is? And how can I trust her with my body if I can’t trust her to remember her own words?

I have no idea what to do next. But the bleeding and cramping keep getting worse. I’ve got to do something.

•••

I hear about a therapist offering a workshop for people with chronic and/or terminal diseases. I figure three months qualifies my problem as chronic and sign up.

“You are in charge of your healing,” James, the therapist, tells us. He does not say to distrust doctors or medicine, but rather that each of us should stand vigil over our health professionals, since we are the experts on our bodies.

“Get a second, third, and fourth opinion,” James advises. “Use different types of healing. When my wife had cancer, she worked with Western doctors but also consulted an acupuncturist.”

I tell James I don’t have the strength to do what he suggests. He says that’s the hard part—no one with a chronic disease has energy. “But have your current doctors helped you?”

“Not really.”

“Then you need to fight.”

•••

I go back to Dr. D and ask her to recommend another gynecologist, and she refers me to Dr. F. I send Dr. F my chart, now two inches thick, along with a note detailing the past four months.

“How terrible!” Dr. F tells me during our consultation. “I’m so sorry you’re going through this.”

I heave a sigh of relief, hold back tears of gratitude. She’s the first of my doctors to express empathy.

After looking at my record, Dr. F asks two questions: “When Dr. C performed your ultrasound, why didn’t he use a contrast dye? And when Dr. E did the endometrial biopsy and D&C, she got no tissue, or as good as none. How can she say you don’t have cancer?”

“Do you think I have it?”

I remember the day I learned about this disease, in seventh-grade science.

“When a person gets cancer, some of their cells go bad and start to kill the good cells,” Mr. Ringel, the science teacher, told us. “More and more cells turn cancerous. The process doesn’t stop until the host is dead.”

Host? A host welcomes guests. How can we use the same word for a body invaded by rogue cells? And am I now harboring this illness that killed my grandparents and later struck my mother and her siblings?

“You’re probably okay,” the doctor says. “But if you were my patient and I had such little data, I would not feel safe assuming you didn’t have it.”

The doctor recommends another D&C. Since she no longer performs surgery, she refers me to her colleague, Dr. G.

Dr. G can’t see me until December 19—a month away. When he finally examines me, he concurs that my uterus is enlarged and a second D&C is warranted.

“Good. Can we do it this week?”

“Unfortunately, my schedule is packed, and with the holidays, we’re short-staffed through New Year’s. I can schedule you for January 9.”

I bristle at his banalities: schedule packed, holidays.

•••

Dec. 22. A bunch of us are grouped around the breakfast bar at friend’s Christmas party. A skinny, bespectacled guy, a friend of the hosts, says, “Did I ever tell you how I killed my first patient?”

We all prick up our ears.

“So, anyway,” Dr. Skinny-Bespectacled says, “I’m twenty-five, I’m a resident, and I’m a real idiot, you know? They’ve got me paired up with this other newbie, Fred. They send us in to—I dunno, do something to the oxygen tube on this guy—the guy was thirty years old and dying of cancer, right? A real tragedy. So anyway, no one tells us how to do this thing, we’re both falling over ourselves, then all of a sudden, Fred says, ‘I think he stopped breathing.’ It was awful. Now you’ve gotta bear in mind that this guy probably wouldn’t have lived much longer, anyway—”

In my head, something kills the volume on the conversation. All I hear are doctors’ voices: Cora Schenberg’s death was a terrible tragedy. But of course, she’d have died anyway.

•••

If offered a wish now, I’d ask for time to speed up. I want the surgery done. But time has slowed to a standstill. It creeps toward Christmas, fa-la-bleeping-la. My family and I hide away from the stores, the hysteria. Wade and I are too tired to throw our usual Hanukah party. On Dec. 31, we’re all asleep before midnight.

•••

January 8, 2013. The night before surgery, the cramping increases. It feels as if something is fighting to get out of my belly. In the morning, I’m filled with relief as we drive to the hospital.

Wade is waiting when they bring me back from the OR.

“The doctor just left. He wasn’t able to complete the surgery.”

“What?”

“He said he got in there and nothing looked like in the ultrasound. He was afraid he’d punctured your uterus and gone into a false channel.”

I don’t know whether to cry or curse. False channel. Cul-de-sac. My body is not a road!

“So what’s next?” I ask Wade.

“The doctor’s going to consult with some colleagues and call you on Monday morning.”

Dr. G does not call on Monday morning. That afternoon, I ring his office. The receptionist tells me he’s out of town. Which words to choose so that this woman will hear me and make sure the doctor gets my message?

“I was in menopause for four years,” I say. “Six months ago, I started bleeding. It keeps getting heavier, and I’m in constant pain.”

“That’s awful!”

“It would really help me to know the doctor’s plans.”

Tuesday morning, Dr. G is still out of town. I leave another message.

By Wednesday morning, I’m desperate. I’ve had to buy yet another family-size box of feminine hygiene product. I know it will just make things worse if I call and yell at the receptionist.

The phone rings; it’s Dr. G. After apologizing for his long silence, he says, “I just got your report back from the pathology lab, and I’m afraid the news isn’t the best.”

Wade steps into the room just as I repeat the doctor’s next word: malignancy.

“You’re saying it’s cancer. What kind? What stage?”

“We don’t know. It’s in your uterus or your cervix, maybe your ovaries. I was surprised there was enough tissue for them to find anything. We’re sending you to the cancer center at the University Hospital. They’ll take care of you from now on.”

I hang up the phone, run into Wade’s arms. I try to feel the warmth of his body, but I’m frozen in panic. I think of all the months wasted, going from doctor to doctor. I remember my friend Mary, who developed symptoms like mine years ago. Mary’s doctor diagnosed her with fibroids, prescribed a painkiller, and said to come back every six months for monitoring. One day, a mutual friend called to say Mary had cancer. Rather than presenting, Mary’s cancer had slunk in silently and set up camp. Free from a doctor’s intervention, the twisted cells multiplied until they pushed past the walls of her uterus and laid claim to Mary’s lungs, heart, and back. She was dead six months later.

“I hope those doctors haven’t killed me,” I say, into Wade’s shoulder. I suddenly remember a cartoon the New Yorker ran just after Mary died. It showed a doctor in a lab coat, doing a silly dance. The caption showed what the patient on the exam table was saying: “Sounds like dance? No, dancer! Cancer! I’ve got cancer!” At the time, I wondered if Mary would find this cartoon funny or think it the most tasteless thing in the world. Since I wasn’t that patient, I thought it wasn’t up to me to say. But now I am that patient, and I hope Mary laughed, because I think that cartoon’s funny as hell. I hold Wade, laughing and crying, until it’s time to leave for work.

•••

February 5, 2013. The instant I meet my oncologist, Dr. Cantrell, time speeds up. Dr. Cantrell looks no older than twenty-five. A slender woman with a brown ponytail and a big, toothy grin, she shakes my hand with a strong grip. After hearing my story, she says, “I’m so sorry you had to go through that. Sometimes even very good docs miss these things. Now, the first thing we need for you is an MRI.”

“When?” I ask, expecting the usual wait.

“When do you get done teaching this afternoon?”

“At two.”

Dr. Cantrell turns to her nurse, Peggy. “Schedule Ms. Schenberg for an MRI after 2:30 today.”

Noticing my expression of disbelief, she grins. “You’ll find things move pretty fast around here.”

A week later, Dr. Cantrell calls with my results.

“Your ovaries and cervix are fine; the cancer’s in your uterus. I recommend a hysterectomy. Can you clear your schedule for surgery on Tuesday?”

“I’ll call my boss now. How much bed rest will I need?”

“Most people go back to work in a few days.”

“How–”

“In most cases, I make a couple of tiny incisions, about a quarter-inch long, then I can remove the uterus vaginally. It comes out like a baby.”

No! I want to protest. Not like a baby. My baby filled me with awe. My baby did not try to kill me.

“Now, sometimes,” Dr. Cantrell continues, “the uterus gets enlarged from inflammation. If it’s too large to remove vaginally, I’ll have to make an incision. That recovery can take four-to-six weeks.”

I say nothing to this, my head still swimming

Before hanging up, Dr. Cantrell teaches me three new words: Endometrioid. FIGO. Clear cell.

After surgery, she’ll order a pathology report. If I have endomitrioid, FIGO grade 1 or 2, my tumor will be classified as slow-growing and non-aggressive, and require no treatment beyond the hysterectomy. However, if clear cell cancer—grade 3—is present, I’ll need chemo and radiation, too.

“Clear cell,” I repeat. These words sound so innocuous. But on second thought, clear cells would be the undetectable kind that sneaks up on an unsuspecting host.

•••

Gabriel joins Wade and me in our bedroom as we watch television.

“Mom,” he says, “I know you don’t want to make this cancer thing public. But is it okay if I talk to my really good friends?”

“Of course,” I tell him. “I’m taken care of. You and Dad need all the support you can get.”

•••

February 12, 2013. The orderly wheels my stretcher into the operating room, where Dr. Cantrell, already wearing her mask, greets me with a hug. Waiting for the anesthesia to work, I place my hands on my lower belly, murmur a silent good-bye to my womb.

I wake to whispers. Someone repeats one word several times before I realize it’s my name and look toward the speaker.

“Your surgery went well,” Dr. Cantrell says. “It looks like stage 1—no sign that the cancer spread. I’ll get your pathology report back in a week or so.”

“It hurts.”

“Unfortunately, I had to make an incision. It’ll take a bit longer to heal, but you’re in great shape. You’ll be fine.”

Flowers, care packages, and cards are waiting when Wade brings me home from the hospital. Gabriel hands me a stuffed penguin he and Wade got me at the hospital gift shop. Friends from the synagogue tell me I’m on the prayer list and ask when they can come by. My sister Kathy arrives to visit and shop and cook for us.

A week later, Dr. Cantrell phones.

“Cora, I’ve got your report.”

“Good news, Doctor?”

“Remember I told you about those three kinds of tumors? I’m afraid you’ve got clear cell–a grade-three.”

The room turns sepia. I struggle to find my voice. “What happens next?”

“We’ll give you time to heal, then, if you agree to it, we’ll start chemo and radiation.”

“How come I need both?”

“This is all based on studies. The latest ones show that when the cancer returns, it usually comes back to the same site. So we radiate that area, to kill any cancer cells the surgery might have missed.”

“And the chemo?”

“The chemo will get any cancer that might have spread into your system. I know I’ve given you a lot to think about. Take a few days to decide what you want to do. Call if you’ve got questions. I’ll support any decision you make.”

Wade, Gabriel, and I sit around the table, not speaking. I try and fail to feel the warmth of their presence or register the soft light from the lamp above the table.

•••

Dr. Cantrell teaches me more new words. The radiation she prescribes is called brachytherapy–placing the radiating source near the former site of my tumor. She explains that with the radiation confined to a small area, I shouldn’t expect side-effects. Yet what I hear in the sound of “brachy” is “break” and “broken.”

I have to train my mouth to get around the words Carboplatin and Paclitaxel, the chemo drugs Dr. Cantrell would use. Their syllables feel arbitrarily thrown together, like bad architecture. Dr. Cantrell does not hide the fact that chemo is poison. While it kills cancer, it also attacks other fast-growing cells, like those in the stomach lining and hair follicles. It wipes out both red and white blood cells, disabling the immune system. I’m reminded of generals who hire mercenaries—thuggish louts who wreak havoc, but get the job done. I sign off on both the chemo and radiation.

•••

February 25, 2013. I’m off from work for at least another month. The chemo and radiation won’t start till April. Meanwhile, healing takes place in the silence that fills our house when Wade and Gabriel leave for work and school. I depend on my body to tell me when to eat, sleep, poke my nose outside for air, and sleep again. From my rocking chair in the living room, I take in butter-yellow walls, a glass-fronted bookshelf holding our favorites, and three cats asleep on the sofa.

I don’t yet know that in September, when my family and I join the congregation for Rosh Hashanah, I will be pain-free, my scar a faint line. That Dr. Cantrell will call me her star patient and say to come back in four months instead of three, since everything looks so good. For the moment, I’m content not to know this. To let time to do what it does, without expanding or contracting, speeding up or slowing down. I’m grateful to rock in my chair, as the winter sun strengthens.

Note: Some names and physical characteristics have been changed to protect privacy.

•••

CORA SCHENBERG’s work has appeared in Brain,Child, Utne Reader, the Delmarva Review, C-ville Weekly, and The Hook; she has also read essays on WVTF radio (NPR Roanoke) and had three plays produced in Charlottesville’s Live Arts Theater (Summer Shorts Festival). She holds a Ph.D. in German literature from the University of Virginia, where she currently teaches.