In between this excerpt and the previous one, Reuben explained to Helen's English teacher what was going on in their family. Helen "downsized" their Christmas decorations from a full-size tree to a table-top tree, and Reuben gives her the set of ornaments he originally gave her mother for their first Christmas. (Helen's mother died in labor, which is discussed in the prologue).
The settings: January 2006; Westwood Hospital, Fiennes house, Pleasant Valley High.
The
first week of January, Dr. Kutzner finally had good news. He told Reuben that
the
cancer
was now retreating, and that he might be in remission within months. Helen
nodded.
“How
many months, approximately?” she asked.
“Possibly
before the summer, but there are no guarantees.”
“Right.”
Helen crossed her arms around her chest. Her ribs felt bumpier. “But what about
the
weight loss? I’m still losing — I mean, Dad’s still losing weight.”
Reuben
gasped, but put his hand over his mouth, waiting for Helen to elaborate. He
thought she had looked a little thinner, but wasn’t sure. Most of the winter
she had worn thick, chunky sweaters and baggy sweatshirts to school, leaving
her smaller shirts untouched. If he asked her why she wore big clothes all the
time, she just shrugged and said they were more comfortable. Given how much
time she spent running around the house or driving him to Westwood, he thought
nothing of it. Before he got sick, they picked so many fights over what she
could wear at home, what she could wear with her friends, what she could wear
at school that he didn’t mind her switching from v-neck tops to hooded
sweatshirts.
Meanwhile,
Dr. Kutzner stopped typing his progress note, and grabbed a lab requisition
form. He filled it out hastily, checking off the boxes for a CBC and blood
chemistry, and threw in a request for an EKG.
“Well,
I would keep pushing the high calorie foods, including proteins and complex
carbs,” he mumbled, “I know you’re adding lots of fruits and veggies, but those
won’t put the pounds back on. Now, Reuben, I’m going to send you down to the
lab for some more bloodwork. Start the new year with a new baseline.”
When
Reuben grabbed his coat, Kutzner motioned for Helen to stay put.
“I
need her help to finish this note,” he told Reuben. “Go get your arm stuck.”
“She’s
much better with this medical stuff than I am,” Reuben laughed dryly.
As
soon as the door closed, Kutzner dotted the last sentence in his note and hit
the save button. He scratched his head for a second and turned around to face
Helen again.
“Did
I hear you say that you’re losing weight?” he asked delicately. He rested his
chin on his hand and frowned, hoping he wasn’t seeing the early signs of an
eating disorder.
“I
used to weigh around one-thirty, and in December I was down to one-ten. I
weighed myself this morning, and I’m down to one-hundred.”
“Have
you seen your doctor about this?”
“No.
I… I don’t really have time for it.” Her head dipped, and her eyes sunk. “But
if I just need to eat more, I can do that.”
“Helen,
I really think you need to see your own doctor. Losing that much weight,
especially at your age, is dangerous. You’re still growing, and you’re putting
yourself at risk for bone and muscle loss. You aren’t trying to lose weight, are you?”
“No!
Of course not.”
“Please,
call your doctor. I can’t treat someone who’s not my patient, but I will tell
you that you should start caring about yourself the way you care about your
dad.”
“You
think I don’t care about myself?” Helen spat.
“I
think you’re taking wonderful care of your father, and forgetting to pay
attention to your own health.”
Helen
stormed out the door and followed the signs to the phlebotomy lab. What did
Dr. Kutzner know about her? she thought.
She still took care of herself. When she felt hungry, she ate the same things
her father ate, just less. Sure, she wasn’t that hungry most of the time, but
it was hard to scrounge up an appetite watching her father poke at his food for
over an hour, clearly fighting violent nausea. She ran, knowing that her father
would almost be done in the lab. They could go home, and she could eat. She had
to. But her vision started fading as she came down the hall. The fluorescent
lights slowly blurred into the white ceiling tiles. Her feet slowed down, and
she clung to the wall. She heard a rush of people down the hall, but the sounds
slurred as a heavy darkness descended in front of her. Just as her legs
collapsed underneath her, she realized how close she had come to what her father
felt when he first got sick.
When
she came to, she saw a fire-engine red code cart to her left and a pair of
middle-aged female nurses to her right. The tall one with a round face had
wrapped a blood pressure cuff around her arm while the slender one with black
glasses pressed her fingers on her wrist, feeling her pulse.
“BP’s
ninety over sixty,” the tall one murmured while the slender one jotted down her
pulse and respirations.
Helen
tilted her head to the side, trying to read the clipboard in the slender one’s
hand. Teenage female found unconscious…
But the slender one quickly jerked the clipboard upright so she couldn’t read
the rest.
“Honey, can you tell me your name?” the tall one
asked.
“Helen
Fiennes. F-I-E-N-N-E-S.”
“Okay.
Helen, I’m Pat. I’m a nurse in the emergency department. Can you tell me what
happened?”
“I
was walking down to the lab and I just felt really dizzy… Everything was all
blurry and then I couldn’t see… Next thing I remember I was on the floor.”
While
Helen talked, Pat looked over her face and arms. Her forehead had more lines
than some of the nurses in the emergency department, but her skin was clean and
warm and she didn’t appear to have any major injuries from the fall. Still, her
blood pressure had been pretty low, which made Pat wonder if she was dehydrated
or had a cardiac problem.
“How
does your head feel?” she asked.
“Fine.
Look, I need to drive my dad home.”
Helen
swiftly lifted herself up into a sitting position and jumped to her feet while
Pat protested loudly, “please, don’t get up yet.”
She
continued walking down the hall towards a tall man with a bare head and
thinning eyebrows. “Dad?” she asked him. “Are you okay?”
“I’m
fine,” he said, slowly. He glanced at Pat and Janet, then the code cart, and
gasped. “Leni, what happened?”
“I fell,” she told him calmly. “I was a
little dizzy, but I’m fine now. I think I just need to eat more. It’s okay,
Dad.”
Motioning
to Janet to grab a wheelchair, Pat turned to Helen’s father. Seeing an
apparently healthy teenager faint at Westwood was somewhat unusual for her, but
something felt off when she saw the girl with her father. Rather than the
father support his daughter, the daughter had her arm behind his shoulder, and
periodically looked up at him.
“Is
the first time this has happened to her?” Pat asked her father.
“Yes,
but I can fix this myself,” Helen interjected before he could answer. “I don’t
need to go to the ER.”
“I
think she’s underweight,” her father countered. “She said something to my
oncologist about losing a lot of weight.”
Pat
sighed. “Janet, get that girl in the wheelchair.”
Helen
squirmed when Janet tried to guide her into a wheelchair chair and jerked away,
seating herself and flipping the foot and leg rests down before Janet could
touch them. While she pushed Helen down the hall towards Triage, Janet thought
about the drunk college student she had to examine while he blabbered about the
strip club where he got totally wasted, man.
Helen was both cleaner and more articulate, but her denial was all the more
irritating because she was sober. Yes, she admitted, she had lost weight, but
when was she supposed to see a doctor? She didn’t have time. When they reached
the Triage room, Janet lept at the chance to irrigate a burn victim’s wounds.
After seeing too many people die in the ED from heart attacks and strokes that
may have been preventable, she had lost her patience for otherwise healthy
people who put off seeing a doctor because “they didn’t have time.”
“Have
Pat see her,” Janet had told the Triage nurse after Helen was sent to a bed in
the ED. “She’s good with the stubborn kids.”
“The
one with all the burns is in Trauma 2. His wife said he tried frying bacon
without any pants on,” the Triage nurse said.
“I
love stupid men with second-degree burns,” Janet chirped as she left the room.
After
Pat took Helen’s weight and vitals and ordered a CBC and blood chemistry, she
brought Reuben to Sasha Pearlman’s office. When Sasha was paged by another
department, her office was considered a prime space for meeting with patients’
families. Her collection of floral watercolor pieces and CDs of nature sounds
were much homier than the plastic chairs and flickering UV lights in the ED
family conference room, whose main decorative features were posters about organ
donation and health care proxies.
“Mr.
Fiennes,” she muttered, “I don’t like how this looks.” She pointed to her
closed chart, and flipped it open to her initial assessment.
“I
don’t know what I’m supposed to read,” Reuben stammered. “Is she gonna be okay?”
Pat
leaned in and jabbed her finger at Reuben as she spoke. “A woman who’s five
four should weigh at least about one hundred and twenty pounds. Your daughter
is down to one hundred pounds. That’s very underweight. I have to ask, what are
you feeding her?” Pat crossed her arms. “If she’s still under your roof, she’s
your responsibility. You have to take better care of her.”
Reuben
scooted his chair back and held his hands in front of his face. “Please, stop.”
“I’m
running some standard bloodwork on her to find out if she’s malnourished,” Pat
continued. “I have to ask, why hasn’t she seen a doctor? I asked her when her
last physical was, and she said it’s been almost a year and a half!”
“Can
I talk?”
“I’m
giving you a minute to explain to me how you didn’t notice your only child
losing thirty pounds in less than three months.”
“I
didn’t think it was that much,” Reuben hesitated.
“Her
ribs and spine are protruding. It’s sick.”
“It’s
my fault,” he choked. He buried his face in his arms and started sobbing.
When
she was a nursing student, Pat jumped the first time she saw a grown man cry.
But in her specialty, strong emotions were a given, and she quickly grew to
prefer the parents who cried to the ones who screamed and tried to hit her when
confronted with bad news.
“What
do you mean by that?” she asked softly.
“I
have leukemia. Helen’s the one who drives me here and keeps house and cooks. I
want to do more, but it’s hard… I thought being in charge was keeping her sane.
But obviously she’s not okay.”
“Can
I get your oncologist’s number to confirm that?”
“Yeah.
Kutzner. He practices here. I have his card—”
“I’ll
page him later. I know who he is. We need to get back to the ED.”
When
Pat pulled the curtain open, Reuben saw Helen in a greenish-white hospital
gown. The color of the gown, especially under hospital UV lights, seemed to
make anyone look sicker just by washing out their skin color. When she shifted
her arm, he finally saw what Pat saw at first glance. Her collarbone jutted out
from her skin, and there were a few faint bumps below it – her first ribs, he
realized. And her once-round cheeks had almost flattened, making her face more
angular, more severe. The IV needle in her hand seemed oversized next to her
small fingers. Her large, round eyes, which were once a subtle reminder of her
mother’s face, now seemed too big for her face. Even though she didn’t look
that healthy, she didn’t look as sick as he did. That, he supposed, was what
kept him from thinking anything was seriously wrong.
For
months, she was so focused on keeping him from getting sicker, that he stopped
worrying about her. The way she telephoned Dr. Kutzner at all hours of the day
at the first sign of an infection and asked every nurse and pharmacist exacting
questions about his medicines made him think she’d do the same thing for
herself. But as he settled into the chair next to her bed and saw her
shivering, he began to recall the way she would stand in the kitchen for
several minutes after dinner, staring out the window above the sink. Today, she
seemed focused straight ahead at the curtain around her bed, then looking up
through the mesh at the top. When she turned her head slightly in the direction
of a child crying, and then looked down at her IV, he could see that same look.
It started out as wide-eyed disbelief and faded into cold surrender.
Reuben
wanted desperately to be able to
talk through what was happening with Pat. When he was the patient, Helen
managed to draw out an explanation of every move his nurses and doctors made.
She would stride after them up to the nurses’ desk and drug rooms and only
leave after they gave her an answer, even if it was “please leave me alone for
ten seconds, I’m charting.” He imagined that they did most of their paperwork
while Helen was in the bathroom or had suddenly fallen asleep. Even now, when
she was trying to warm herself up under a thin hospital blanket, he kept
waiting for her to ask Pat when they’d get her bloodwork results and what types
of conditions she was in the process of ruling out.
***
When
the bloodwork finally came back, Helen did ask Pat to show her the numbers and
to point to her results before showing the normal ranges. She was pleased to
note that her blood counts were mostly normal, even if they were near the lower
end of normal. As she scanned the second page of results, Pat circled the low
results. There was one abbreviation she hadn’t remembered from her father’s
blood tests, hCG. She poked at the word with her pointer finger until she found
an asterix next to it, which directed her to a note that an hCG result of 0-1
was consistent with no pregnancy. Hers was 0, not that she expected otherwise.
“Don’t
take it personally,” Pat muttered, “I test almost every woman under 50. Better
safe than sorry.”
“That
makes sense,” Helen replied meekly.
“Obviously,
I’m happy you’re not pregnant. Sure your father is too. But your iron is low.
You’re starting to run low on protein and white blood cells. That’s not good,
especially if you’re the primary caregiver…” Pat’s voice sunk at the end of the
sentence in what sounded to Helen like disapproval. “You said you’ve been doing
this for a few months? And you lost thirty pounds? God.” She turned to Reuben. “I’ve talked to Kutzner, and
he shares my concerns about your daughter’s health. I’ve seen this kinda thing
with much older women, women my age, with kids, who take care of their parents.
It’s terrible. Women martyr themselves for their families, and no one notices
until they get sick.”
Reuben
jolted in his chair. “You think I just let this happen?”
“I’d
like you to tell me who else is supposed to do it,” Helen snapped. “My uncle
can’t be trusted with money or prescription medications, and their parents used
to hit them. I’ve had setbacks, but I think I do a lot better than most of
those women. They have too much shit to do, and so they don’t ask questions or
do their research like I do. I read up on nutrition and infection prevention
and I tell other people in the outpatient clinic what they should do—”
“Look
at yourself,” Pat ordered. “You’re in the emergency department. You think
you’re smart and in control because you do a lot of research, but you are not
in control at all. You’re drowning, and you’re telling people not to worry
because you can tread water. You need a lifeboat, kid. And you need one with
high-calorie provisions.” She dialed an extension that Helen didn’t recognize.
“I’m getting a Psych consult and a dietician.”
Ten
minutes later, Pat handed Helen a bottle of chocolate high calorie Ensure. Her
father’s tight frown melted a little. “Like father, like daughter.”
Just
before six, Pat signed Helen’s discharge papers and sent them to the pharmacy.
Helen tucked her prescription slip inside her handbag until she was at the
counter. She studied the orange bottle she received, initially paying more
attention to the color and shape of the pills inside than the name of the drug
on the label: sertraline. It was generic Zoloft, the pharmacist giddily
explained. The psychiatrist in the ED was similarly bubbly when she mentioned
the drug. Though she was careful not to promise any kind of quick fix, she
exclaimed, “once the serotonin kicks in, you’ll be eating like a regular
teenager again!”
A
regular teenager. Ha. Helen tried to laugh as she recalled what that entailed.
Fighting with her father about which shirts she could wear at school and which
she could only wear at home. Trying to convince him that the party at Kristen’s
house would be a dry party, even if there would be some senior boys who had
been featured in the police log for underage drinking. Going to any parties,
whether they were only labeled “dry” by Kristen’s laissez-faire parents or
actual dry parties, the kind where people watched movies and played board games
up into the wee hours of the night. She supposed that many of her peers had
been on anti-depressants or stimulants (for ADD) at some point, but she
resented only sharing teachers and DSM diagnoses with her classmates. Most of
the fun parts of high school seemed to have left her, or faded into background noise
over the past three months, and popping pills was not going to change that.
***
After
Helen finished getting dressed and strolled into the kitchen, she did a double
take. Just to make sure she was awake, she pinched her arm. In front of her
chair there was a plate loaded with French toast topped with butter and syrup.
She checked the sink for dirty dishes, and found the skillet, prep bowls and a
flipper in the dishwasher. Satisfied, she sat down to eat, but didn’t feel like
eating more than a few slices. Her father stepped out of the bathroom in his
robe and looked down at her plate, frowning.
“Aren’t
you going to finish it?”
“I
feel full.”
“But
you need to eat more.”
She
held her hand over her stomach. “I’ve had enough to eat. This is way more than
I’ve had for breakfast in a long time.”
“But
you only had three slices.”
“I
don’t need eight slices of French toast! You eat them!”
“But
I made this for you.”
The
last time Helen had seen her father wince that much was when he had food
poisoning, so she went ahead and cut up the fourth and fifth slices and forced
them down. At this point, she went from feeling bloated to being stuffed. Being
forced to eat by emotional manipulation did not sound like anything the
psychiatry resident or the dietician recommended. Apparently all her father had
heard was to increase her caloric intake. She looked up at the glass next to
her plate, which looked like it had chocolate milk. But knowing how much Ensure
she had stocked up for her father, she took a cautious sip before chugging it.
When it hit her tongue, it tasted like watered down chocolate milk with a touch
of salt and several spoonfuls of sand.
She
was suddenly reminded of a time when she and Lydia, when they were nine years
old, thought it would be fun to pour spoonfuls of crushed animal crackers,
salt, and sugar into their milk and drink it. The taste and texture was worse
than they thought, and once Lydia’s mom had left the kitchen, they dumped the
stuff down the sink. Right now, she desperately wanted the sink option.
“What
did you put in here?!” she shrieked.
“A
few ounces of protein powder and a little salt, to get your blood pressure up
so you don’t pass out at school.”
“A
few ounces?” she choked it down, barely.
“You’re only supposed to put in a tablespoon. That’s what I did for you.”
“But
this gives you more calories.”
She
offered him the glass. “Try it yourself.”
To
her surprise, he drank almost all of it. “You’ve pushed this stuff on me so
long I’m almost used to it. How about I give you a bottle to have with lunch?”
“If
you think I’m drinking Ensure at school, you’re crazy.”
“Remember
your pill.”
Helen
still thought Pat and the psychiatrist had overreacted. Despite her insistence
that she wasn’t depressed, just tired, they handed her the prescription and
gave her the meeting time of a caregivers’ support group at Westwood. There was
a meeting this afternoon, which her father told her he would drive her to after
school. She swallowed her setraline with a few ounces of water and followed her
father out to the car. He was going to work a mid-morning through lunch shift,
when it would be less chaotic in the kitchen.
The
two of them walked up to the driver’s seat, but Reuben got in first, sliding
the seat a foot back. Helen merely frowned before going around to the
passenger’s side.
“What’s
wrong?” he asked.
“Nothing,”
she said, gritting her teeth.
At
school, Helen saw a flier for the spring musical auditions. This year they were
going to put on The Sound of Music. She
remembered the rehearsals for The Wizard of Oz often stretching from the end of school to six or
seven at night, and sighed aloud. Maybe next year she could do it, if the drama
club would consider her. Its members were so tightly-knit, between taking drama
and music classes together since middle school, and the fall plays and spring
musicals. They were happy to let her put on a blonde wig to be Glinda last
year, but she wondered if they would still remember that a year ahead. She
wanted to do something, anything, besides go to a support group.
Her
lunch group was enough support for her, even if they had an odd way of showing
it.
Summer
asked her to hold still as she took a bite of her apple at lunch.
“Huh?”
Helen mumbled through her teeth.
She
blinked at the flash from Summer’s camera. For artistic reasons that she did
not understand, Summer insisted on only using film cameras. Today, she brought
in a Polaroid camera, and waved the film in the air before setting it down by
her sketchbook.
“You
have very expressive lips,” Summer told her, as though that were an
explanation. “Even when you eat. They’re so hot.”
Helen
lifted her eyebrows, and then resumed chewing.
Keith
scoffed, “Leni, you’re like her fuckin’ muse or something. Own it.”
“You
should model,” Summer added, pressing her fingers to Helen’s cheeks. “There’s
so much emotion in your face.”
“What
do you call what I’m doing for you now?” Helen asked with a playful smirk.
“You
know, you can get paid to pose for art classes. You should consider it, for
college.”
“Right.”
“Mrs.
Lane keeps asking me who I’m drawing,” Summer noted. “Really.”
Helen
grabbed a piece of paper out of her math notebook. “Maybe I’ll start drawing
too.”
Summer
tilted her head just off to the side, as though she were looking over her
shoulder. “You’ve seen me and Keith do it all the time. Go ahead.”
Helen
went ahead, trying to follow the lines of Summer’s face one by one. She started
with the hairline and Summer’s spike pixie cut, then down the sides before
tackling the jawline and chin. “It doesn’t look right.”
“It’s
a start,” Keith said.
Summer
moved her head back to its previous position, and tapped Helen’s shoulder. “I
didn’t want to say anything, but are you okay? Your collarbone’s been looking
kinda pointy.”
“I’m
working on it.”
***
Helen
followed the directions to the support group and found herself on the Westwood
Inpatient Oncology Ward. They were supposed to meet in the family conference
room, whose doors were flanked with what the nurses called the Flower
Brochures.
The
Flower Brochures had high-resolution pictures of flowers and nature scenes
splashed on the front page, to
counteract titles like “When Your Spouse Has Cancer” (a lone dandelion),
“Making End of Life Choices” (a tree whose leaves had almost all fallen) and
“Balancing Care Responsibilities for Parents and Children” (a waterlily with
several dewdrops on the petals). Helen left the brochures behind, and entered
the room, hoping to find a seat in the back. But the chairs were arranged in a
circle, and there was only one empty spot… right next to the leader of the
group, Sasha Pearlman herself.
“It
looks like we have a newcomer!” Sasha announced. “Please, introduce yourself.”
Helen
looked to her right and left. The rest of the circle seemed to be made up of
women in their forties through sixties with grey-blue bags under their eyes.
There were six of them. Three were steadily munching from individual bags of
chips, or sipping milkshakes. Glancing at their rounded waistlines, Helen
wondered if their problem was stress eating, and felt a twinge of disbelief.
How was food supposed to help them with their problems? Then she remembered her
food problem. Her father had pressed a protein bar into her hand when he picked
her up from school, and scolded her for not eating enough when he heard her
stomach rumble.
“Go
ahead,” Sasha prompted her.
“My
name is Helen, but I go by Leni.”
“Tell
the group why you’re here, Helen.”
“Leni.”
“Please,
Leni, go ahead. This is a safe space.”
“Fine,”
Helen assented. “I’m here because a psychiatrist made me go.”
“Leni,
generally we share who we take care of, how long we’ve been doing it.”
“Okay,
okay. God.” Helen rolled her eyes. “My dad was diagnosed with chronic leukemia
last October. I drive him to Westwood and cook and stuff.”
“Thank
you, Leni—” Sasha murmured.
“How
long do these things go?” Helen asked, unwrapping her protein bar.
“That
depends,” Sasha answered curtly. “Let’s continue.”
“Leni,
I’m Brenda,” said one of the women with a bag of chips. She wore a grey cotton
track suit and white sneakers, but she had her peroxide blonde hair slicked
back into a tight, high ponytail. “I’ve been taking care of my mother-in-law
part-time for about five years now. She’s got dementia, so I mostly just do
shopping, cooking, the mail, oh, and some housework. Almost all of it. But my
husband drives her to church on Sundays.”
Helen
frowned. “Why doesn’t your husband take care of her? I mean, she’s his mother.”
Sasha
bit her lower lip, staying silent, but Brenda glared at Helen.
“He
just doesn’t have time, Leni,” Brenda said coolly. “I’m sure there’s a good
reason that you’re the one taking care of your dad and not your mom.”
“Yeah.
My mother died when I was a baby.”
Brenda
gasped. “Oh, God, I’m so sorry.”
“Please,
don’t.”
“Rachel,
why don’t you introduce yourself,” Sasha suggested.
“Okay…”
Rachel hesitated. Rachel, like Helen, was quite petite, but she appeared to be
naturally small. She was very short, so her slim wrists and tiny hands seemed
proportional to her body. “I’m Rachel. My son was just diagnosed with leukemia,
and his trashy wife dumped him after she found out. So I let him move back in,
and I guess I do a lot of what Leni does. Cooking, driving… Laundry. He’s so
tired all the time.”
They
continued around the circle: Polly had an autistic daughter, Leslie, who was
taking care of a mother-in-law with dementia, and, finally, Tina, whose young
son had Down syndrome and whose father had multiple sclerosis. Helen left the
meeting feeling a pit in the bottom of her stomach. When she got to the parking
lot, her father greeted her brightly and asked how the meeting went. She
shrugged.
“Were
the other people nice?” he asked.
“Sort
of. But they were so sad. I don’t get how this is helpful.”
“I
think the point is to meet other people in your situation.”
“But
they aren’t like me. They’ve all been doing this longer than me, and none of
them are on anti-depressants.”
“You
don’t know that.”
“No,
I do. We had to talk about why were referred to the group. A bunch of them are
on blood pressure medicine, but I’m the only one on crazy pills.”
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