“Feel free to have children,” the doctor said. “Just know you probably won’t live to see them grow up.”
I stared past him at the sheen of the window. Ice crystals branched along its surface, blurring the slushy traffic of the fading Boston afternoon.
This oncologist had become protective over the years. Though clumsy in his delivery, he intended a kind reminder.
As a 33-year-old with one year of marriage and three bouts of a rare unpredictable cancer behind me, I needed no reminding. Any child I had would develop in my damaged abdomen, stretching its web of scars. This child would then grow up forever linked to my uncertain health. Time and again I wondered – is it fair, wise, or kind to bring a child into the world knowing I may not live long?
Before cancer, parenthood seemed a hazy reverie. My life was saturated with happy hours, graduate school projects, second dates, medical school applications. Blissfully busy, I surged forward with plans for career and companionship. Children were encased in the cozy scene of a snow globe, kept on a closet shelf.
Then, over months, my belly grew oblong and oddly firm. Instead of fluttering with a fetus, it bulged with the dullness of a tumor. The mass pushed all the nearby organs to the periphery. It halted my momentum. The doctors called it sarcoma. I named it The Bastard.
Immaculately conceived by the mutations of my own genes, it was birthed surgically. Weighing more than the average newborn, it greeted the cold operating room silently. No one took its photo or stamped its footprint. A nurse delivered it to the pathologist in a sterile bundle of towels. Its birth and death were one.
A fresh cancer survivor, I began my education as a physician, grateful for a preoccupation. Our professors explained one must understand the well in order to understand the diseased. Eager for all that was vigorous and healthy, I sheltered in the dim medical school library, devouring details of the body’s usual functions, memorizing the cycle of orderly cell growth and mastering the structures of normal anatomy.
Normal only lasts so long. Soon, in the laboratory and on the hospital ward, we witnessed all the ways a body can stall, wither, break and fail. How cells can grow awry, multiplying into malignancy. How brittle the nature of our inner selves can be, how often unpredictable our corporal course. How despite attempts to prevent and heal, we ultimately lose control.
I cared for lives that ended unexpectedly at every stage. The pregnancy lost at 14 weeks, when hope was just beginning. The three-year-old who tumbled out of the upstairs window, head cracked like an eggshell. The 17-year-old at last given a new heart, only to die of complications before his next birthday. The 45-year-old, fresh from celebrating her ten years in remission, whose X-ray for back pain revealed the smudge of metastasis.
Cancer had lifted the veil of control; training in medicine reinforced my sense of the relentless uncertainty of life. My wrinkled white coat was a flimsy barrier, easily exchanged for a hospital gown if any of my every-six-months MRIs found recurrence.
Life on such an edge was too uncomfortable. So when as a medical student I found myself at the threshold of the patient’s room, her distinctive bald head amidst the well-wishing balloons and bouquets, I hesitated.
I escaped to read her chart, thick for one so young. It was a story that started like mine: Cancer diagnosed at 25 – the cause of her bloating not her love of cheese, but a sneaky mass on an ovary. Cut out and radiated and blasted with chemotherapy, it had resurrected, returning after her 28th birthday.
“She won’t make it to 30,” the supervising physician told me. “Sad,” he quipped.
I condensed my morning visits to her room, silencing my usual small talk, leaving only time for the necessary – vital signs, her pain level, any overnight changes. I left little space for the empathy medical school expected. If I let it in, I might disintegrate at the foot of her bed.
How could I hope to help others face fragility when I could barely bear to grasp my own? So I honed my denial, sequestering thoughts of my mortality. I was not like her, I told myself. I was different. I would live far beyond 30. I conjured a boundless future, sustained by years of clear scans.
Then, months before medical school graduation, a reminder appeared. The tumor was a blip, puny and solitary, found before it could damage its surroundings. Telling classmates I was taking an oncology elective, I squeezed another surgery between my final clinical rotations. I rushed to recover, to hide my new scar. I donned my cap and gown, tumor-free, eager to reattempt hope.
* * *
In the next cancerless years, I met the man who would become my husband. We fit our dates in between my long resident shifts at the children’s hospital. One May evening, full of tempura and warm sake, we plotted a life together brimming with dogs, tropical holidays, and children. I moved into his attic apartment, hanging art and buying a new bedspread. We jetted to Spanish beaches, and flew home to meet each other’s families.
Months later he proposed over pancakes. The verdant emerald on my finger became a happy distraction during hospital rounds. Rapt with the flurry of wedding planning, I barely remembered my upcoming scan.
My third tumor was an uninvited guest at our wedding. It hid deep beneath my lace bodice, hugging my kidney and nudging my colon. It waited quietly as I recited vows under the summer sun, ate strawberry rhubarb pie and danced at dusk. It grew slowly as we honeymooned on the Canadian coast, eating steamed mussels and introducing our Labrador puppy to the ocean. It lodged firmly as I sat under an expanding sky, toes buried in the red sand.
I returned to Boston, tan and anxious. I sat in the banal fluorescence of waiting rooms, the September leaves rustling just beyond wide windows. Doctors scheduled another surgery, some suggested radiation. Unable to shield my ovaries from its waves, this therapy would assign my fertility its fate, withering my eggs to empty shells, their potential lost. I envisioned my children, a faint shadow to start, now consumed by darkness.
Yearning for another option, I dissected study after study in the medical school library, disheartened to find so few. I took road trips, my medical records stacked in the backseat, to listen to second and third opinions, sitting in stiff chairs, hearing risks and benefits, lackluster outcomes and uncertain guarantees. No evidence could assure radiation would improve my prognosis, so I chose to fight for my fertility and have surgery alone.
This tumor resisted eviction, glued to the unassuming organs nearby, making surgery prolonged and strenuous. I awoke in the chilled recovery room, my breath shallowed by a chest tube, my mind clouded by fentanyl. Friends and residency colleagues came to distract with gossip and jokes. I suppressed my laughter; it was too painful for my split, hollowed abdomen. Perhaps, I thought, the collateral loss of my kidney, spleen and chunk of colon would leave more room for a baby to nestle? I pushed away such thoughts, distracted by pain and pureed food.
In the next weeks, as my belly wove itself back together and my single kidney learned to excrete alone, my brain recalled a train ride from Paris to Nantes. With a baguette and Brie and plastic cups of wine balanced on the pull-out tray, my future husband and I had imagined how many children we’d have – two, no three, maybe four?
Now, I wanted to try for even one. But I also wondered if my desire for a child was really a desire to avenge my treacherous body, replacing the monstrosity of malignancy with the magic of new life. Was a child a selfish attempt to perpetuate my genes, a way to eclipse my own death? If my mothering time was cut short, would my child resent me?
Perhaps if my disease had a trusted timeline, a sure statistic, a predictable path, answers would be transparent. When I pressed my oncologist for a forecast, she counseled, “Live as best you can in whatever time you have.”
I wanted an expansive life, one that, even if sparse in years, was saturated in love. Our child would join an ample clan of grandparents, aunts, uncles, cousins and, of course, a father. I imagined our child living without me, learning all I wanted to teach her – how to paint, to bargain shop, to prune blackberries, to heal a broken heart – from another. She would not be alone. I could provide only the launch, then entrust others to guide the voyage. We chose to accept the risks and create life.
Soon my belly swelled perceptibly. The weeks marched forward, calmed by the rhythm of a steady heart and the jolts of tiny feet against the ultrasound probe. Friends patted my bump; I welcomed them. I savored my gravid form. It was hope made flesh.
To ensure our child had no unwelcome cancerous neighbors, I squeezed my bulging self into an MRI machine, the tech wedging in an extra pillow and wishing me luck. Afterward my oncologist shared the good news – the scan found no sign of recurrence. Then he showed me what had never appeared on any of my other scans: The contour of a nose, the angle of a chin, the curve of a belly – the parts of my perfectly growing child, outlined in shades of gray on the screen. This was no tumor, dull and bleak. It was alive and wriggling, even in black and white.
Soon the baby, prone to flipping, attempted a feet-first arrival. So on a balmy November evening I waddled buoyantly into the operating room. Draped in blue, I waited to greet our child, staring at the striped towels arranged on the infant warmer nearby. As a pediatrician, I’d stood by in hundreds of Cesarean sections, anticipating a lusty cry, that heralding pronouncement of life. My eyes always welled, fogging my sterile mask.
Our daughter emerged, petite and glistening, wailing as my tears surged. She quieted, resting her clasped hands under her chin. Our hands were nearly the same, both long-fingered, hers chubby and dimpled, mine veiny and gnarled. She lay content in her father’s arms as the doctor sewed me up, leaving a short new scar perpendicular to my outstretched old ones. We brought her home in time for Thanksgiving dinner. She weighed less than our turkey.
Sooner than I thought possible, her fingers were picking the frosted raspberries off her first birthday cake. She squeezed their juice with joy. I snapped photos of her wide, stained grin. Amidst the squeals of “Mama!” and the ripping of wrapping paper, I paused, amazed to be there. Here, in the joy and chaos, was the worth of life. And like the bright party confetti fluttering down to cling, sparkling, to our socks, I was sticking longer than expected.
I still tend to measure life in six-month intervals. Such presentness feels safer. Some days I’ll daydream about her second grade concert, her middle school science fair, her college graduation. I will be happy if I am here for such moments, but I do not expect to be. I can only parent in the time my delicate cells allow.
My daughter and I often explore the meadow nearby our home. She stoops to examine the shimmer of frost on a fallen leaf. She rubs the contour of every dug-up rock. She stands transfixed as snowflakes vanish in her warm palm. She pauses, eyes toward the sky, with every bird’s trill or airplane’s hum. Her giggles mingle with the rushing hum of the stream as it courses under the receding freeze of April. She smiles up at me before toddling forward.
With a child, time is fluid. It can surge with a springy quickness – a new word each day, pants abruptly too short, crawling that becomes standing, walking, running all within weeks. Or it can meander with a syrupy slowness, the world captured in a day.