Love and Medicine

I expected Dr. Robert Lamb to be a brash, quick-moving former pre-med like the ones I’d slept with just after college. But when I met him in the exam room, he had Teddy-bear eyes, large and approachable. He was pudgy and long-limbed, somewhere in his mid-thirties. I loved him immediately. 

“What can I do for you?” he asked, when I sat on the crinkly paper.

“I’ve been having intense stomach pain,” I said. “On and off for the past year.”

Dr. Lamb smiled and the skin around his eyes folded like batter coming out of a mixing bowl. He asked if I’d done any elimination diets, and I rattled off the various foods I’d attempted to isolate in my search for a cure: soy, dairy, gluten, legumes, nightshades, and once—palm oil.

“You’ve done your homework,” he said. 

I glowed. I had an urge to call him Robert, to praise him like he was one of my students. Then he said he wanted to do a fecal test. 

“So we can see what kind of inflammation is happening,” he said, “and whether it’s happening in your stomach or your intestines.” He handed me a clear plastic baggy full of tubes and pointed the way to the bathroom. 

In the bathroom, I wept. I do not like shitting into tubes, but of course I have been through it before: the shaking thighs as I crouch above the toilet seat, hand at an awkward angle to catch the shit, the latex gloves they give you to convey sterility. There is nothing clean or precise about scooping your own feces into tiny tubes. The stench, for one, is unbearable. And the shame of playing with your own excrement follows you the rest of the week. 

I couldn’t look Dr. Lamb in the eye when I brought my baggy full of shit back to him. We did not have an auspicious beginning.

***

When I arrived at school the following day, Asmeret knew something was up. Asmeret is my co-teacher. She’s calm and whip-smart, and has a way with our more volatile students. As we pushed the desks into islands of four, I told her about meeting Dr. Lamb. If I took out the part about shitting into a cup, it almost sounded like a date. Asmeret knew I’d been going through a dry spell since moving back to New Jersey, spending far too many nights alone on my couch. I’d even Googled how to foster a dog before remembering I was allergic and my teaching schedule would never permit all those early morning walks.

“He’s a gastroenterologist,” I added, over the screech of rusted metal on linoleum. “So maybe he can help with my stomach issues.”

Asmeret rolled her eyes. “Julia,” she said. “You know love and medicine don’t mix.”

Our students burst in then, and I had to shout over the roar as they took their seats. 

“Who can read aloud the poem on the board?” I asked.

Leticia raised her hand and read about the icebox and the plums, so sweet and so cold. 

“That’s not a poem, Miss,” she said when she finished. “That’s a note.”

“Good,” I said, waving my arms enthusiastically. “Who can tell me—what’s the difference between a poem and a note?”

Several students sighed audibly. Finally, Alberto raised his hand. Alberto is old for eleventh grade and not so skilled at writing. He works as a mechanic when he’s not in school, and he saunters into my class with greasy hands. I swoon a bit for students like Alberto—the ones who try, who smell good and take notes. 

“A poem says something important,” he said. “I dunno if this is a poem.”

“Okay,” I said, switching the slide to a poem by William Carlos Williams. “Read this one aloud.” 

Alberto did as I asked, stumbling over the words. It was about an old woman sitting in the street, devouring a plum.

“They taste good to her,” Alberto said slowly, squinting at the screen. “They taste good to her. They taste good to her.”

***

I should say that my parents are doctors. This has always been a defining fact of my life. They are both intense, fit people with above-average intelligence. My mother is a gynecologist, trained in the former Yugoslavia before emigrating to America in the chaos of the late ’80s. She answers all questions from government officials with a fervent “God bless America,” even postal workers and parking cops. She still harbors massive guilt at not having been there for the Siege of Sarajevo. She was a gynecology resident in New York, treating wealthy women struggling to conceive while her family in Sarajevo went without meat, without fruit and vegetables, and then finally without bread.

My dad is a gastroenterologist, descended from a line of Jewish-American intellectuals, many of whom were also gastroenterologists. He and my mother met during their second year of residency and married two years later, the same year my mother’s mother died of complications from pneumonia. My grandmother was only fifty-eight. Had she been in New York City—where chocolate milk and half-priced chickens were abundant, where you couldn’t walk down an avenue without stepping on a doctor—she would not have perished. As it was, she slipped out of this life in an apartment building with no heat, and now I have her name.

Needless to say, I had a very well-monitored childhood. I was a chubby kid, and so I was weighed more frequently than most. My difficulty breathing was taken as a symptom of a larger issue related to stamina and lung capacity. When I turned eighteen, my mom insisted I see a gynecologist. I could go to a friend of hers, she said, but it would be easier if she saw me herself. When I climbed onto her examination table, her shoulders relaxed. The doctor-patient relationship has always made more sense to her than the mother-daughter relationship. 

“And are you sexually active?” she asked, her eyes flicking down to her notes. 

“Oh,” I said, thinking of my first boyfriend, who insisted I give him a hand job, and of the second, who slipped into me before I was ready. “Sort of,” I said.

My mother raised her eyebrows. “The pill doesn’t prevent STDs,” she said. “Who are these boys anyway?” 

I was about to answer when she shook her head. “Never mind,” she said. “Medically speaking, I don’t need to know. But we should test for STDs.” 

She called in her nurse to draw my blood as she continued her recitation of my body compared to other bodies. The nurse gave me a consoling smile. She removed the needle and pushed a cotton swab into the crook of my arm. 

“We’ll do the pap next,” my mom said, rolling into place and putting a papery blanket across my lower half. I shifted myself down the table and she pushed my knees apart. Then she probed, slipping her fingers inside and palming my abdomen. I disconnected my brain from my body. It helped to separate myself like that. I thought of the two red oak trees in our backyard, how when you looked up at them from below, their leaves were like hands waving hello.

“Ovaries are good,” she said. “Uterus feels fine.”

She took the speculum from the tray and her fingers were replaced by cold metal. Then the long brush went in and scraped, a sensation that made my toes tingle. 

“It itches, right?” she said, her face hidden from me by the paper blanket.

“Yeah, it does,” I said, surprised by my sudden tears.

***

I wore perfume to my follow-up appointment with Robert, a fresh, peachy scent that smelled like domesticity and sex. When Robert pointed out elevated levels of calprotectin in my lab results, I quoted from a Web MD article I’d read before my appointment.

“Calprotectin is an indicator of inflammation,” I said. 

“Right,” Robert said, and I preened. “You may have an inflammatory disease or a bacterial infection.”

“What do you recommend?” I leaned toward him on the pretext of looking at my chart, my heart-shaped necklace dangling over my cleavage. 

Robert sat back in his chair. “An endoscopy would be the next step,” he said. “Shall I schedule you for next week?”

“I’ll find a sub,” I said.

We stood, and on impulse I went in for a kiss. I meant for my lips to brush his cheek in a sort of European ambiguity, but he turned his head to say something, and my mouth collided with his teeth. He pulled back, surprised.

“I’m going to see Moonstruck at The Frederick on Saturday,” I said, recklessly. “You should come.”

“The Frederick?” Robert echoed, sounding dazed.

“Cher and Nicholas Cage, I don’t know how you could resist,” I went on, hoping my tone was teasing and light, but it might’ve sounded desperate. I slipped out of the room before I could make a bigger fool of myself.

On Saturday, I hung around the lobby of the movie theater until I started to feel pathetic, then went inside and took a seat. I would stay for ten minutes, I told myself, and then I would leave. Robert arrived after the opening credits.

“Sorry I’m late,” he whispered, stepping over my knees to the seat next to me. 

I barely paid attention to the film. At one point, I rested my head on his shoulder and he put an arm around me. It was both paternal and romantic. Afterward, I invited him to my place for tea. 

“I don’t usually do this,” he said, following me up the three flights of stairs.

“You’ve already gone through my shit,” I said, laughing.

We were in bed before the kettle whistled. I found myself weeping when I came. He was surprisingly rough, which is how I like it. He held me afterward, sweaty and spent. 

“Could you lie on top of me?” I asked.

He chuckled, but did as I requested. The air left my lungs. I felt both sated and aroused.

“Why gastroenterology?” I asked. The effort of speaking made my head swim.

“I’ve always liked internal medicine,” he said. “The gut is the deepest part of a person, the most interior system. My patients come to me when they’re experiencing discomfort or embarrassment. They’re vulnerable. It’s an incredibly intimate thing.”

He shifted off me and ran his hand from my collar bone over my breasts to my stomach. A series of emotions danced across his face: desire, pride, possession. Then he covered my mouth with his and I pulled him back on top of me. 

***

I tried to be a doctor, I really did. The heroism of the medical profession had been drilled into me my entire life: medicine was the ultimate calling, the most challenging, admirable thing a person could do. But I was not a stellar student, and my advisor encouraged me to major in the humanities. He said he was only looking out for my happiness. When I told my parents I’d switched my major to English, they asked if I was still pre-med.

“No, but I’m studying the great American poets,” I said. “Emily Dickinson. William Carlos Williams.”

“William Carlos Williams was a doctor,” my dad said.

The bar was always so high, and I was always so far below it. 

After graduation, I did a teacher-training program in Chicago. I lived on coffee and granola bars and, for the first time in my life, I had a lot of sex. In my euphoria at being noticed and desired, I was not always gentle with my body. I slept with older men, with sad men, with finance bros and community organizers. I liked the med students best, the angry orthopedists-in-training and the fuckboys clawing their way to anesthesiology. My body to them was something to be tested. I was a mouth to bite, a pair of legs to wind around their waists. I began to think of myself as a collection of organs and limbs, and by the end of my first year in Chicago, I had a pain in my stomach I could no longer ignore. When I flew back home for the holidays, I mentioned my symptoms to my dad. 

“Come in for a check-up,” he said. He had me do a breath test that involved exhaling into a bag. Then he took my blood. In a few days, the results came back. I had an ulcer, he said, treatable with a series of antibiotics. He was pleased; he loved problems that had neat solutions. 

“The body is like a book,” he said. He was standing outside my childhood bedroom, my lab results clutched in his hand. “It’s not too late to do a post-bac.”

***

Back in Chicago, I read William Carlos Williams’s Doctor Stories and came across an essay written by his son. Apparently, William Eric Williams became a doctor, too. He wrote about his dad’s wild schedule, how he saw patients from dawn until well past nightfall, visiting hospitals, making home visits, and delivering babies—and still, he found time to write. A stolen moment between patients to bang on the typewriter, or a scribbled note on the way to a delivery. Here is a man making his living at medicine who has given up medicine for poetry, the younger Williams wrote. It demanded time and energy, and he would supply both bountifully, often at the expense of his family.

I wondered at the difference between a body and a book, between medicine and poetry. I wondered about this when I slept with the eighth-grade history teacher. We did it in his classroom right before a long weekend, and I was too distracted to insist on protection. The burning sensation and the blistering sore on my vagina emerged when I was home for the summer a few months later, just in time for my annual with my mom.

“Julia,” she said, when she had me on the table. “Were you ever going to tell me?”

“I thought it would go away on its own,” I said.

She prescribed antiviral pills for the worst of the herpes symptoms, but I would never be free of this latest mistake. I would have to be more careful, she said, looking at me with restrained scorn.

When my parents drove me to the airport at the end of the summer, I told them I wanted to see other doctors.

“I just think it’s time,” I said, as my dad merged onto the highway. I tried to catch my mom’s eye in the passenger seat, but she was looking out the window at the trees zipping by. When I was little, she’d take me on walks and point out the red oaks, the silver maples, the gingkos and ash. She liked to collect pine cones and smooth slips of birch bark and line them up on the table until they disintegrated into wood chips and dust.

When my mom finally spoke, she didn’t take her eyes from the trees. “Who would care for you better than your parents?” she asked. I didn’t know how to respond. 

Three months later, in the chaos of moving apartments for the fourth time, I missed the window to pick up my birth control pills. I visited pharmacy after pharmacy, begging them to call my doctor for a refill. Each one insisted that the patient had to make the call. I couldn’t tell them that my doctor was my mother, that we were currently enduring an icy patch in our relationship. In the end, I wanted contraceptives more than I wanted to prove a point.

“What do you need?” my mom asked when she picked up my call.

“I’m a week behind on my pills,” I said, “and I haven’t found another doctor yet.”

I gave her the phone number of the pharmacy near my new apartment. I sensed she was biting back a torrent of feelings: annoyance at my chronic carelessness, smugness that I still needed her. When I moved back to Newark at the end of my teacher training, I went to her office for a check-up. Aside from my herpes, she gave me a clean bill of health.

***

Robert and I went on two more dates after my endoscopy. I took him to a ramen place by my house, and was taken aback when he ordered for me. I’d been a vegetarian for years, but when the beef udon arrived, I ate it without comment. 

“I knew you’d like that one,” Robert said, watching me slurp the noodles. 

On the next date, he took me to an arcade where he played Pac-Man. Each time the little yellow man sank to the bottom of the screen, he pounded the machine with his fist. 

“It’s okay, babe,” I said, as if calming a child.

“I swear I used to be good at this,” he said.

I stood in front of the screen and wrapped my arms around his neck. He sighed, and whispered an apology into my hair. I felt such power then, that I could subdue him, make him liquid and contrite.

When his name popped up on my phone the following week, I thought he was calling to ask me on another date. I was on my lunch break, sitting at my desk in an empty classroom. 

“Your results are back from the endoscopy,” he said when I picked up. “This is, ah—hard to say.” 

“Oh?” I heard tapping, maybe his pen against a pad of paper. I picked at my sandwich, pinching the soft wheat bread into bits.

“You have stomach cancer,” he said.

I waited for my body to respond to this news. I waited for the panic, the heart-plunging surprise. But I felt nothing.

“Adenocarcinoma, stage two,” he went on. “The best course of action would be surgery. I think we should move quickly.”

“I thought you were calling to flirt,” I said, managing a laugh.

Robert didn’t speak for several long seconds. “I’m sorry,” he said. “We should really concentrate on your health.”

And there, finally, was the panic. Was he breaking up with me? 

“You’re upset,” he said, reading my silence. “Come to my office and we’ll talk.”

“I have to call my parents,” I said, and hung up. 

I dialed my mom’s office before I had time to chicken out.

“I have stomach cancer,” I said, when her receptionist patched me through.

I heard the clunk and rustle as she switched me off speakerphone. Of course, she wanted to know which doctor I’d seen. “I’m calling your father,” she said, and got off the phone.

I clutched my stomach as my students filed into class. Asmeret was in front, leading the eleventh-graders from their lunch. 

“Can you take over?” I asked her. “I have to deal with an emergency.”

Asmeret nodded, bewildered. I drove to Robert’s office, then dialed his number when I arrived. He emerged five minutes later, scanning the parking lot for my car.

“I wanted to ask you,” I said, when he climbed into the passenger seat, “not to leave me.”

He opened his mouth, then closed it again.

“I mean as my doctor,” I clarified. “Could you please still be my doctor?”

“Your dad just called,” he said. “Why didn’t you tell me you’re Dr. Friedman’s daughter? He’s extremely well-known in the field.”

“I don’t know,” I said. “I’m sorry.”

He was breathing hard, and I could tell he was only barely holding onto his control. 

“Did you tell him about us?” I asked.

“Did I say that I’m sleeping with his daughter?” He laughed dryly. “No, I did not.”

I reached across the console. What I wanted more than anything was not to make a scene. 

After several long moments, Robert seemed to gather himself. 

“We should go over the plan for surgery,” he said. He explained the process of removing half of my stomach and reattaching it to the small intestine, how everything could be done laparoscopically, with small incisions and a camera. I was impressed and in love all over again. 

“I think we can avoid chemotherapy,” he said. “If the surgery is successful.”

I repeated this plan to my parents when I saw them later that night. My dad, it turned out, disagreed. He folded his hands on the table in front of him, glasses sliding down his nose. We were at a Thai place near their house, a restaurant I knew would be packed. I didn’t want to be alone with them if things got emotional. 

“You have to be aggressive in these cases,” my dad said. “You’ll do chemo.” He looked like his own father then, at once authoritative and removed. I wondered if he could see me, or if I had transformed in his gaze into someone else.

“I looked into this Dr. Lamb,” he went on. “He’s inexperienced. I have a colleague, Dr. Rosetti. He’s been treating patients with gastric cancer for forty years.”

“Dad,” I said, holding up my hands. “I’m not switching doctors.”

“This is my area of expertise,” he said. “I would feel much better—”

“Dr. Lamb found the cancer, didn’t he?” I said. This shut him up. My dad had been my doctor once. He’d missed the cancer.

“I’ve taken the week off work,” Mom said, changing topics. 

“You don’t have to do that.” 

“Who’s going to take care of you?”

“I’m seeing someone.” 

“You have a boyfriend?” Her voice was clipped, her Eastern European accent more pronounced when caught off guard. I knew she hated to be left in the dark, knew her worst nightmare was that I’d suffer for lack of care.

“Yes,” I said. 

“And he’ll clean your wound? Help you go to the bathroom?”

“He’s very good at those things.” 

“You’ll still need your mother,” she said, and she spooned more curry onto my plate.

***

During the two weeks leading up to my surgery, my mother sent me texts. They’d come randomly throughout the day. Hi Julia, she would say. I ordered too many socks. Do you want some? x Mom. She always signed her texts like that, as if I didn’t have her number saved. Sometimes, her texts came at night, after I had Robert lie on top of me. I’d see my phone light up on the bedside table. Came across a quote from Anton Chekov, she said the day before the surgery. “Medicine is my lawful wife, and literature is my mistress.” x Mom. Sometimes, I’d respond. More often than not, I left her texts unread.

My parents drove me to the hospital on the morning of the surgery, and Robert met us in the waiting room. 

“Dr. Friedman and Dr. Friedman,” he said, shaking both their hands. “We’ll take good care of your daughter.”

The surgeon came over then. She was around my parents’ age, short and direct. Everyone shook hands again. Four doctors grinned at me, their eyes like glittering water, unknowable and strange. I wished they would go away. It was a relief to go under. I dreamt nothing at all. 

When I woke, everything from my hairline to my ankles ached and I had to re-learn eating. My esophagus was traumatized—that was the official medical term—and my stomach grossly misshapen. 

“When is your boyfriend coming?” my mother asked.

“I’m tired,” I croaked. “Are there more ice chips?”

Then the curtain moved aside and Robert was there. He untied the strings of my hospital gown and felt my abdomen.

“How is this?” he asked.

“Tender,” I said, shivering at his touch.

***

My parents took me home the following week. They waited until I was settled on the couch to start badgering me about chemo. 

“Dr. Lamb says I won’t need it,” I said.

“He’s inexperienced,” my dad said. “You should start chemo right away.”

“Could we talk about this later? My boyfriend is coming.”

“So we’re finally going to meet him?” my mom asked.

My phone buzzed at my thigh. Robert was outside. One minute, I texted. 

“He’s actually a doctor, too,” I said to my parents.

Robert and I had decided we would wait until I was home to tell them, and then he would come over as my boyfriend. I was deluded enough to think this would work. 

“Are you crazy, Julia?” my mother hissed as my dad went to answer the door. “He could leave you in a second.” 

“You and dad were my doctors,” I said. “I don’t see how this is different.”

Robert kissed me when he came in, then greeted my mother.

“When did you start seeing each other?” my mom asked.

“About a month ago,” Robert said.

“Before or after the diagnosis?” 

“Before,” I said, though I wasn’t sure if that was the right answer. 

“This a blatant conflict of interest,” my dad said, breathing heavily. “Julia, you need a new doctor.”

“Robert is my doctor,” I said. Then I screwed my eyes against a new stab of pain. Robert and my mother both rushed toward me, but Robert got there first.

“It’s okay,” he said. “Just breathe.”

***

So began the long recovery. Mostly, my parents and Robert traded shifts. I could only be left alone for a few hours before I needed help to eat or pee. I was losing hair and losing weight. Shitting was still impossible, so there was a scooper and a bag. 

Asmeret dropped by with a giant cardboard sign from my students. They had attempted a poem. This is just to say, they wrote. We hope you feel better, not worse. We don’t want to see you in a hearse. Then they signed their names in purple and red marker around the poem: Leticia. Karim. Alberto. Jackie.

Asmeret stayed until I had to use the bathroom, then walked me to the toilet and hovered outside while I peed. 

“I’m going crazy,” I said, through the door. “So many doctors, and all this pain.” 

“Just listen to your body,” Asmeret said. “You know yourself better than anyone.”

“My body and I aren’t on speaking terms at the moment,” I said. I flushed and washed my hands, elbows resting on the sink for balance before Asmeret helped me back to the couch.

After the second week, I told my parents they didn’t need to come every day. I had Robert, I insisted. He was very attentive. 

“You need to start chemotherapy,” my dad said, for the hundredth time.

“Robert wants to wait,” I said.

My dad left the room, fuming. Later, when Robert stopped by with a container of soup, my dad confronted him directly. 

“I could sue you for malpractice,” he said. 

“Jesus, Dad,” I said. 

“Julia’s treatment plan is based on emerging research,” Robert said, “research that says chemotherapy this early on might do more harm than good.”

“Your negligence will kill her,” Dad shouted. “You cannot be her doctor and her boyfriend.”

“Oh, and being her parent and her doctor is better?” Robert shouted back.

“That’s enough,” I said. I used my teacher-voice, and it reverberated around the tiny kitchen. I made my parents go home. My mom was tearful when she left. She said I was exhibiting post-surgical psychosis, which sounded like a made-up term. 

Robert was still blowing off steam when I returned to the kitchen. He stirred the soup vigorously, splotches of yellow broth landing on the stovetop. 

“You trust me, don’t you?” he asked, turning from the stove to me. 

I nodded, and he held my face in his hands. His grip was too strong, and I felt like a peach just past ripeness. When he released me, I ran my fingers along my jawline, feeling for a bruise.

***

I went back to teaching the following month. My students shrieked when they saw me at my desk. I hadn’t realized they missed me so much. Or perhaps they were alarmed at my weight loss; I’d had to tie my pants up with string. I took my place at the front and opened my mouth. But there was a sheen in front of me, and I didn’t know what was supposed to come next.

“They were about to start Poe,” Asmeret prompted.

Somehow, I made it through the lesson, and then the rest of the day. 

“Something’s not right,” I said to Asmeret after the last bell. We were collecting spare print-outs from the desks. “I think the cancer’s back.”

Asmeret froze, Poe’s story about the tell-tale heart clutched in her hand.

“Do you think it’s possible Robert and I can just be lovers?” I asked. “Like, not doctor and patient, just—boyfriend and girlfriend?” 

“I don’t know, Julia,” she said, biting her lip.

I made an appointment at an oncology clinic in Philadelphia. The doctor was a kind-faced woman with an Indian accent. 

“You were right to come in,” she said. “Most doctors would’ve started chemo right after surgery.”

I felt my resected stomach drop even lower. “Do you have a daughter?” I asked.

“I—no,” she said, taken aback. “I have a son.”

“Does he want to be a doctor?” I asked.

She gave me a concerned look, like I wasn’t asking the right questions. “Come back for the first round of chemo next week,” she said. 

I had to tell Robert about the chemo. He would notice my symptoms, and I needed someone to drive me to appointments. I hoped, naively, that this would be no big deal. But his face turned red when I told him.

“I’m trying to take care of myself,” I said.

“Bullshit,” he said.

“I still want to be your girlfriend,” I insisted.

I wasn’t prepared when he pushed me against the wall. My head collided with the door frame, and I blinked stars out of my vision. 

“I knew it,” he said. “You don’t trust me. You never did.”

His eyes were glassy, his expression one of despair. I was about to disappear, about to disconnect from my body until it was over—when he started crying. Then he pummeled his own chest with his fists until I could wrestle his arms to his sides. I had an impulse to speak to him as I would to a student, stern yet kind. But he wasn’t my student, and I couldn’t treat him like one of my boys. When he left several hours later, he told me not to call.

I was too proud to tell my parents about the doctor in Philadelphia. They thought I was still with Robert, biding my time until the cancer returned, and I didn’t correct the assumption. I went to my first chemo appointment alone and stared out the window as a nurse attached the IV. I was about to drift off when my phone buzzed. It was a message from my mother.

Hi Julia, she said. I read an article about a fungus attacking trees in New Jersey. Beware of falling branches. x Mom.

I unlocked my phone, squinting at the blurry screen. I was woozy from the drugs, but I wanted to respond.

How do I know if a tree is sick? I typed. I only had to wait a minute for her response.

There are signs, she said. You just have to keep looking up.