Dissection, p.6
Dissection, page 6
But it is time to return to work. She starts to walk in the direction of the clinic and with each step her irritation increases. She will keep the cosmetics, but not because she believes they will help her ageing skin or, for that matter, help in any other way: together they constitute neither active treatment nor placebo. They are simply an admission — these fragrant creams in their opaque glass jars, these snake-oil elixirs of youth — an admission that she (despite her scepticism, her knowledge of histology, her years of devotion to cruel, hard fact) is as vain and foolish as any other woman of her age.
She is in the bath. She has locked the bathroom door. The water, still warm, gently laps against her thighs and over her stomach. Leaning back against the edge of the bath she idly regards the length of her body. For someone who spends so much of her time in the examination of naked flesh, it is strange that she rarely gives her own body more than a cursory glance. She is naked now and, at this minute, in no particular hurry: what better time to take stock of herself? Time to look at her breasts, at the flattening of the upper curvature, the smattering of dark hairs around each nipple. Beneath her breasts the skin of her abdomen, softly crinkled and loose from pregnancy, is strung like a hammock between the two iliac spines. And then, the convexity of her hips and outer thighs: how preserved the skin is there, how white and smooth. If only she had always stayed out of the sun! She looks along the curved line of the quadriceps muscle to the knees with their bony patellae, the soft flesh of their inner borders. This is her body: no more, no less. The ordinary body of a forty-three-year-old woman, weathered, perhaps, a little more than most. Is this how other people see her?
She turns onto her right side, her legs bent, and notices how the refraction of the water’s surface makes it look, from her angle of sight, as if her left leg is separated, mid-calf, from the rest of her body. The longer she lies in this position, the easier it is to believe. She stares at her left foot until its very appearance becomes grotesque, like a plaster fake that has somehow ended up in this bath beside her. A clean, painless cleaving: would that it were always so. The water is getting cold and Joe is knocking on the bathroom door, calling to her.
March 22
On Saturday morning she takes Joe to his drama class in South Yarra. They are running late, so she drops him at the theatre then drives around the neighbouring streets until she finds somewhere to park. She turns off the engine and sits for a while. The sun through the windows gently heats the car interior so that it feels pleasantly lazy to sit, doing nothing. As she begins to drift off to sleep, a thought comes to her from nowhere: she has wasted her opportunities, wasted the opportunity to live not a better life, but a safer one. A safer, more comfortable life: that is what she wants. If she had chosen more wisely along the way — law, perhaps, or commerce, instead of medicine; plastic surgery instead of general practice; long, lustrous hair instead of a short cropped style that probably makes her face look too thin — she might, at this exact moment, be buying her weekly flowers from the florist at the end of this street in preparation for her dinner guests, instead of sitting here, alone in her car, uselessly thinking. Perhaps it is just the sun through the window, or the eerie quiet of the street in which she waits, but she has a sudden dislocating sense of all things crystallising, the events of her life overlapping and aligning so that a pattern emerges, a pattern of choices that has led her, inexorably, to this moment of reckoning.
She shakes herself awake, out of her reverie. She has always been prone to reflection on days such as this — the autumn sunshine, the sky, at late morning, cloudless and blue, yet the air still cool. Autumn is always a time for reflection. A gentle southerly breeze wafts perfectly, so that as she lowers the window she feels the cool air on her face, curing her drowsiness but leaving her feeling as if she has just awoken from a deep sleep, unsure of her surroundings. It is this street, too, that has set her thinking: this tram-tracked street of Victorian terraces and lush front gardens where palms sway stiffly and red begonias bloom on upstairs balconies; where, around the corner at an expensive café opposite the gardens, she will soon sit and drink coffee while she skims the Saturday newspapers. This understated wealth, the gentility of this suburb unsettles her so that she begins to think of choices and consequences, of having and forgoing, of never wanting in the first place but, perhaps later, when looking at the red flowers on an upstairs balcony, of coming to regret one’s youthful resolve.
From inside the car she watches two men standing on the pavement. They are inspecting the car parked in front of her — a black Alfa Romeo, sleek and new. The older man is doing most of the inspecting, walking around the car and taking photos of it from different angles. The younger man lifts the bonnet and her view of them both is obscured. She imagines them leaning over the engine and fiddling with caps and bolts like excited schoolboys. The bonnet is set down with a gentle clang. The men return to the pavement and continue talking, their eyes still on the car as though it might vanish should they let it out of their sight. The negotiation, if that is what it is, appears to be going well. The older man smiles and strokes his neat, white beard as he listens to his companion. Occasionally they both break into restrained laughter.
The older one is dressed as if ready for work, in a pale pink business shirt, a tie and belted trousers. A daring colour, pink, for a man in his fifties, which he appears to be. He has a pleasant face, wide and smooth above his beard. Through the open car window she thinks she hears a Scottish accent, a soft, refined Scottish brogue carried to her on the breeze that ruffles the bearded man’s hair and rustles the leaves of the garden palms. She wonders if he lives nearby. Having come here, perhaps, from the cobblestoned streets of Edinburgh, he might find a small remnant of home in this leafy suburb, with its cafés and bookshops, its claims to a dignified history.
The two men shake hands: it seems the negotiation is complete, at least for the moment. The older man gives the younger one his card. He then crosses the street and turns the corner, a spring in his step. She imagines him going home to his wife to tell her of his purchase. You and your cars, his wife might say, kissing him on his cheek, her top lip brushing the smooth skin above his beard, and she is again brought to thinking of choices and consequences, of the possibility of lives other than the one she is living.
April 2
In the practice of medicine most things are arbitrary. This is what she tells herself as she climbs the wheelchair ramp each morning, and again in the waiting room where, every time she enters, a dozen expectant faces turn towards her. Most things are arbitrary: she should tattoo it on her wrist.
Of course there are still some absolutes: it is wrong to intentionally harm a patient, for instance. In most circumstances, but not all, it is wrong to break confidentiality. It is always wrong to enter into a sexual relationship with a patient. But for the rest, the day-today interactions, it seems to her now to be more an issue of style than of substance. Whether to review a patient in one day or two, to order investigations immediately or at the next visit: such decisions she used to make in a considered manner, as if she were able to judge from some sort of elevated position, looking down at all the facts, the risks and benefits, the full stretch of medical knowledge laid out beneath her, to come to some sort of absolute decision, the right decision, about her patient’s care. Now she sees, with startling clarity, that these decisions were not right, but relative.
In medical school, in first-year sociology, she was taught about the relativity of medical treatment, at least with respect to the patient. A doctor’s management, the lecturer had said, must take into account the patient’s individual circumstances. Treatments should be tailor-made to fit the old and the young, the poor and the rich; culture, gender and beliefs must be respected and catered for. She has known all this for a long time. But until now she had always thought herself a constant in the doctor–patient equation.
This new relativity she has discovered is in regards to herself in the role of doctor: a role she plays with less and less conviction. Her past experiences; her irrational, at times subconscious fears; her feelings about the patient before her; the time of the day — evening clinic is always more anxiety-provoking, she can admit that now; her level of fatigue: these things and countless others, the antitheses of reason and factual knowledge, insinuate themselves into her rational, conscious decision-making process, so that what she produces is not the right decision in any absolute sense but, instead, an arbitrary compromise, hurriedly patched together from a thousand shadowy, niggling impulses.
If her decisions are arbitrary, they are less valuable than she had previously thought. Her decisions, being arbitrary, must therefore lack conviction. Doesn’t conviction imply a belief in the absolute? She no longer believes in the absolute, nor in absolution.
On her afternoon off she visits Sophie with some food — an orange cake, bought from the bakery, and some homemade soup. She is careful to knock quietly at the front door, in case they are sleeping.
Sophie answers the door, still in her dressing-gown, the baby squirming on her shoulder. ‘Thank God you’ve come. Now I can have a shower.’ She follows Sophie into the kitchen and places the cake on the bench, the soup in the refrigerator. Sophie hands her the baby. ‘She’s been so unsettled this morning. I’ve hardly been able to get to the bathroom.’
‘Have your shower now, and I’ll try to get her to sleep.’ She feels as if she is speaking to a child. She carries Rosie into the bedroom and lays her on the change table. Rosie starts to cry. ‘There, there,’ she sings. ‘It will all be over in a minute.’ She undoes the disposable nappy and checks it for dampness. It seems completely dry, so different from those flimsy towelling nappies she used for her babies: the two-hourly changing, the cheap plastic pants that split and tore, the inevitable nappy rash. But, when she thinks of the billions of disposable nappies now lying in landfill all over the planet, she does not regret the inconvenience. She does not even regret the nappy rash her sons had to endure: surely everyone, even babies, must suffer a little for the sake of a greater good? Suffer the little children. She would like to think she has brought up her sons to consider the greater good.
She places Rosie, still fretting, in the cot, then finds a cotton blanket and swaddles her firmly. Attached to the head of the cot is a pull-ring toy clown. She pulls the cord and the clown dances to a music-box version of Brahm’s lullaby. Rosie stops crying and lies still; she is listening to the music. Maybe she will sleep, after all. She leans against the side of the cot and waits until the music stops, then pulls the cord once more. She does not remember waiting by the cot for her sons to fall asleep but then she, too, would have been impatient to escape to the bathroom or the phone. Besides, her sons would have sensed her there, hovering over them, would have smelled her milk, the particular scent of her body and would have cried to be picked up and fed. But Rosie does not demand this of her. She watches as the baby’s eyes close, while the lullaby slows then peters out.
While Rosie sleeps, she and Sophie sit in the kitchen, drinking coffee and eating cake. The house is quiet and warm. Sophie’s hair, still damp from the shower, is starting to curl in wisps around her face. Two small circular patches of milk have seeped through the front of her T-shirt.
‘Do you want another baby?’ Sophie asks.
How can she begin to answer? ‘I’m almost forty-three.’
‘So? You know it’s still possible. Do you want another baby or not?’
‘It’s complicated, Sophie.’
‘No, it’s not. It’s actually very simple.’
A memory comes to her: that of Sophie as a thirteen-year-old, standing in the kitchen, nagging for new clothes as her mother chops carrots for dinner. ‘My friends get more clothes in a month than I get in a year,’ Sophie complains.
‘Maybe your friends have more money than we do,’ she chimes in from the family room, where she is studying at the table. ‘Maybe your friends are just spoiled.’
Sophie gives her a withering glance, then turns her attention back to her mother. ‘It’s not fair,’ she whines, over and over, to be stopped only by her mother’s soft, defeated cry of pain as the vegetable knife slices cleanly through her finger. Red-faced with indignation, the quick-burning indignation of an older sister, she strides into the kitchen and slaps Sophie across the face. ‘You stupid, selfish bitch! Now look what you’ve done.’ She sees herself wrapping a clean tea towel around her mother’s bloody finger while Sophie stands rigid, wide-eyed, her hand to her smarting cheek.
She tells her patients who ask that the chance of miscarriage is one in five. She has heard other figures used — one in four, one in six — nevertheless she sticks with one in five because she believes the concept of risk, in this case at least, to be slippery, evanescent; like a shining fish in a stream, never to be caught and held in one’s hand. Does it matter to the woman who miscarries if the risk was one in five or one in a thousand? Despite all the statistics in the world, her loss remains her loss: a private thing, essentially immeasurable. A loss of part of herself, in a way. As to how much of oneself is likely to be lost, there is no ready calculation at hand. To the pregnant woman who does not ask, she says nothing of risk. Why spoil her excitement? There will be time enough to be anxious later on.
A woman called Emma comes to see her. She confirmed Emma’s pregnancy just three weeks ago: a happy occasion, as far as she can recall. Today Emma looks worried.
‘How are things going?’ she asks. She smiles expectantly but is careful to keep her question general.
‘I am bleeding,’ Emma answers.
She tries to organise an ultrasound. She phones the local imaging centres but cannot get Emma an appointment that day. ‘You will need to go to the women’s hospital,’ she tells her. ‘They will do an ultrasound there. I will write you a letter to take with you.’
‘Does this mean I will lose the baby?’ Emma asks.
‘Perhaps.’
‘Is there anything that can be done to save it?’
‘No, nothing. I’m sorry.’
She sees Emma again, three days later. Emma has miscarried. Crying, Emma tells the story: how her bleeding and pain increased after she got to the hospital, how her husband steadied her by holding her hand during the ultrasound examination. She had lain on the bed, straining to interpret what she saw on the monitor as the doctor moved the probe back and forth across her skin. Try as she might, she could make no sense of the shifting grey shapes she saw on the screen. ‘Where is my baby?’ she asked the doctor. Emma tells of the shaking of the doctor’s head, of his final words before he left the room: ‘I’m sorry, but we cannot find a beating heart.’ Does Emma worry that, in some dark corner of her womb, unseen by medical eyes, a tiny heart still lies feebly beating?
Emma wants to go over events leading up to the miscarriage, although nothing may have led to it in a causative sense. These things just happen, she could say to Emma and she would be right. But surely something or someone must be to blame. Emma wants to examine the time of conception. ‘Was I drinking too much? Did I have a vitamin deficiency?’ Emma wonders aloud. How far back should Emma go? How much of her past should she lay open to scrutiny? If Emma is to search for all possible answers, she must start at the beginning, at her own conception. ‘Did I overexert myself, or work too hard?’ Emma asks. ‘Was it right to have sex so early in the pregnancy?’ She is worried that, during climax, the shudders of her womb have shaken her foetus from its moorings. ‘Should I have abstained from intercourse, deferred my gratification for the sake of my baby?’ Emma wants to know. The answer is no and yes. While she can reassure Emma on the question of sex, the answer to the larger question is yes: of course a woman’s pleasure must be deferred for the sake of her child.
Blood and pain, hallmarks of illness and injury: the former seen and measured in millilitres; the latter only felt and therefore, in medical terms, a lesser symptom. Better, perhaps, for a woman to bleed by the bucketful and feel nothing at all. And yet the pain of a miscarriage: one could strap a monitor to a woman’s abdomen and observe the tiniest of blips as the uterine muscle barely flickers. Nothing like the fierce contractions of labour, yet a hundred times worse. Blood and pain and absence: a hollowing out, when all she yearns for is fullness and presence.
‘Do you have children?’ Emma asks through her tears. She asks because she needs to know if her doctor truly understands. If she must share her secret with someone, then let it be someone with children. She might better ask of her doctor: Have you ever had a miscarriage? But it is unlikely Emma will go that far. Talk of children is sunny, open and wholesome; miscarriages are whispered about in airless, dark places. Now that Emma has been to that place, she will not expect others to follow.
‘Yes, I have children,’ she replies. She does not say she has miscarried, too.
April 11
William’s teacher, Mrs Hammond, sends her an email, asking to speak with her about William’s general behaviour. She is surprised by this: William’s behaviour, both at home and school, has never been an issue before. She meets with the teacher the following afternoon. They sit in the classroom on the children’s blue plastic chairs, low to the ground. The room is a mess, the bookcases crammed and untidy, the rubbish bin overflowing with paper. On the floor, underneath the blackboard, workbooks teeter in a ragged pile.
‘William is a lovely boy,’ Mrs Hammond begins. ‘Focused, considerate of the other children — but you probably already know this.’ She clears her throat, adjusts her glasses. ‘It’s just that lately I’ve noticed a change in him.’
‘In what way?’
‘He’s more distracted. He doesn’t volunteer answers any more, he’s not as careful about his work. And there was an incident in the playground last Friday. It’s difficult to know exactly what happened — William and the other boy involved have conflicting stories.’
