It all started with the loose tooth. Number thirty-one, the second molar, back right. Though Ruth dreaded the prospect of another extraction, at eighty-seven, with her gums soft as putty, it wasn’t particularly surprising. Things could have been a lot worse at her age. Look at Rose Trembley from church, periodontal disease in her late fifties and dentures by her seventieth birthday. Dr. Jin had already extracted Ruth’s second molar on the left side two years ago, once a root canal was no longer an option. The procedure had been quite unpleasant, but not nearly as bad as Ruth had expected. Dr. Jin was a fine oral surgeon whom she trusted implicitly for her meticulous presentation, her consummate professionalism, and her liberal use of anesthesia.
“How long has it been loose?” she asked, peering into Ruth’s mouth.
“About two months,” she told her.
“Any pain?”
“It’s a little achy sometimes. Mostly it’s just an annoyance, waggling around back there. I’m afraid I’ll swallow it one of these days.”
“Let’s get an X-ray,” she said. “See what we’re up against and go from there.”
Ruth took this as an encouraging development. It was a long shot, but maybe the tooth could be saved after all. Maybe the wiggling was attributable to a tissue infection, or gum inflammation, or something of the like. Perhaps an antibiotic would cinch up that slacking gum and buttress the molar.
But when had life ever presented Ruth the best-case scenario?
“There’s a mass,” Dr. Jin explained over the phone the following afternoon. “Could be a cyst, nonodontogenic, possibly an ameloblastoma. I’m going to go ahead and order a biopsy, so we know what we’re dealing with.”
“A biopsy?”
“Just to be safe,” said Dr. Jin.
The following Wednesday morning, Ruth snatched her car keys and her mask off the credenza on her way out the door.
“See you in a little while,” she called out to Abe.
“Where you going?” he said, appearing in the foyer.
“I told you yesterday I had to go to town this morning.”
“Where, though?”
“T&C,” she said.
“Oh, good. Could you pick up some of that homemade sauerkraut from the deli section?”
“Dr. Channing says sauerkraut is loaded with sodium, and that’s bad for your blood pressure.”
“Yeah,” said Abe. “But it’s good for my digestion.”
“Your digestion isn’t the problem,” she said with a peck on his cheek.
Though Ruth had always considered herself a terrible liar, she was near certain that she’d avoided Abe’s suspicion on this occasion, and so long as she returned with a few items from T&C, she’d be in the clear. Where was the use in worrying anyone when it was probably nothing? Hadn’t Dr. Jin said as much herself? Still, as Ruth tried to discount such a possibility, there was a chance that it was something more. It would have been a relief to share the information with somebody, Anne, or Kyle, or Maddie, but Ruth didn’t tell a soul about the mass or the biopsy, not even Bess Delory.
Instead, she went about her business as usual the next week, scrupulously adhering to the timeworn rituals and routines that had marked her life with Abe the past twenty or so years. Breakfast at seven a.m., sourdough toast (the twelve-grain was full of lectins), coffee for Ruth, prune juice for Abe along with his medication, after which Ruth rinsed and loaded the breakfast dishes and generally busied herself keeping order in the household, making the bed, feeding Megs and letting her out in the backyard to pee, balancing the checkbook, and taking the recycling out to the bin. All the while, Abe read the newspaper, then dozed for a half hour or so in his chair. Upon awaking, he went to work on the crossword puzzle as he always did, Ruth assisting him when solicited, while she watched HGTV’s new Farmhouse Fixer.
“Ten-letter word for ‘expressionless’?” Abe asked. “Ends with D.”
Though Ruth made a brief show of considering the answer, she couldn’t begin to get her mind around a crossword in her state of preoccupation. “Ten letters?” she said. “Goodness, I have no idea.”
“What about six letters, ‘hybrid women’s clothing’?”
“I’m not even sure what that means,” said Ruth.
Each afternoon that week, according to custom, Ruth prepared their big meal of the day, typically one of the five or six quick and easy dishes she’d adopted since they’d become more health conscious, a menu that included, among other fare, chicken breast with cottage fries, salmon and avocado wrap, shrimp and pasta, and Abe’s least favorite of the bunch, quinoa salad. These meals were invariably followed by a nap for Abe, a fifty-minute interval during which he swore he never slept, though his snoring suggested otherwise. That he still refused to wear his CPAP had become a frequent point of dissent in recent months. His unwillingness to endure the minor inconvenience of the device for Ruth’s sake was edging toward a legitimate grudge.
“Minor inconvenience?” he said. “You try strapping that contraption on! Every time I open my mouth, I’m like a human leaf blower.”
“One of these mornings, you’re just not gonna wake up, you know?”
“Good,” he said. “Then I won’t have to hear about it anymore.”
Every evening that week, Abe and Ruth sat together as usual in the living room and watched the five o’clock news, and the six o’clock news, and the seven o’clock news. And for all the normalcy and comfort of the routine, Ruth found it difficult to belie her mounting anxiety regarding the biopsy results. She should have known that after seventy years Abe could see right through her.
“What’s eating you?” he asked during a Cialis commercial.
“Eating me?” she said, even as she felt the blood rushing to her face. “What makes you say that?”
“You’ve been awfully quiet this week,” he said.
“Have I?” said Ruth.
“And forgetful, too,” he said.
“What did I forget?”
“Well, first you forgot those items at T&C on Wednesday, then, when you went back to get them on Thursday, you forgot your wallet and came back empty-handed. Then there’s the fact that you haven’t been much help with the crossword this week.”
She almost told him then. But given a second chance to come clean, Ruth balked once more.
“I suppose I’m just a little worn out from the party still.”
“See? I told you not to make a big production out of it.”
“Oh, but it was wonderful, wasn’t it?” she said. “Having everybody together like that?”
“It was all well and good,” said Abe. “I just worry you push yourself too hard.”
“Can’t a girl be tired?” she said.
But Abe clearly wasn’t convinced, and for good reason, as she would learn in bed that night.
“When were you gonna tell me?” he said.
“Tell you what?”
“About the biopsy,” he said. “The referral came in the mail this afternoon.”
“Oh, that. Dr. Jin said it’s probably nothing,” she said.
“So, why didn’t you tell me?”
“I didn’t want to worry you over nothing.”
“Nothing, huh?” he said, turning his back on her.
“Okay, I’m sorry,” she said.
But Abe had already settled into an ominous silence. For the next hour, he tossed about under the covers as Ruth lay perfectly still next to him. He had every right to be angry and she knew it. As much as anything, transparency had accounted for the success of their marriage, for it encouraged them to resolve their disputes and overcome their differences, so that they were never left to fester beneath the surface. Frankness and candor begot trust, trust begot connection, connection begot empathy, and ultimately it was empathy that had cemented their partnership by allowing them to absorb their losses and overcome their obstacles collectively.
As small as this evasion on Ruth’s part may have seemed on the surface, the omission flew in the face of an accord they’d been honoring since 1954. Thus, it wasn’t until Abe’s fitful snoring began that Ruth’s guilty conscience allowed her to sleep.
When she awoke shortly after dawn the next morning, Abe was not beside her in bed, nor was he occupying the darkened bathroom. Instead, Ruth found him in the kitchen, flat-footed in his ancient slippers, his back turned, too deaf without his hearing aids to sense her watching him from the doorway, his scrawny calves exposed beneath the hem of his old bathrobe, his shoulders stooped, his bald cranium pale and speckled, his bony fingers struggling with a stack of coffee filters even as a pair of blackened eggs wheezed in the skillet and the toaster began smoking.
God, she loved this man. Whatever he may have lacked in utility, he made up in attentiveness and reliability.
Ruth approached him deliberately from the side so as not to startle him. Still, he was oblivious to her presence as she considered him in profile. Take away the wrinkles, and the age spots, and the chin wattle, and Ruth still recognized the sturdy twenty-year-old Abe Winter she’d first encountered at the University of Washington too many years ago to count.
“I should have told you,” she said. “I just thought…”
“You’re right,” said Abe, his eyes evasive. “It’s probably nothing.”
Winter was almost upon the farm, palpable in the cool, still air of the hallway and the chill of the floorboards penetrating Ruth’s slippered feet Thursday morning on her way to the kitchen, where a brisk draft greeted her in the pantry as she gathered the coffee grounds, the filters, and the loaf of sourdough.
Preparing breakfast, she watched Abe out the kitchen window, scraping the ice from the windshield of the old Subaru. Despite his stoop and his diminished work rate, Abe refused to acknowledge the limitations of decrepitude and had managed to remain capable and competent into his ninetieth year, though she hoped he didn’t break his neck out there slipping on the ice. Ruth admired Abe’s intractable conviction that he could do anything a healthy forty-year-old could do. For all the strength imbued in the young, who thoughtlessly tempted their fates as though it were an act of heroism, it was a fact that they took their vitality and recuperative capacities for granted. Nobody under eighty truly understood what it was to resist—nay, to fight back against—that greatest outside force of all, that thief of minutes and days, death. Everything was a high-risk proposition after eighty. To rage against the dying of the light sometimes meant shoveling the walkway or driving after dark.
Once again, the crisp bite of the coming winter greeted Ruth as she navigated the steps cautiously and proceeded toward the idling car, where Abe hunched behind the wheel like a scarecrow in an overcoat.
“Feels like snow,” she said as she fastened her seat belt.
“I hope not,” he said. “I’d hate to shovel that damn walkway again this winter. We should have moved to Arizona thirty years ago.”
As much as he liked to joke about relocating to sunnier climes and leaving the sodden charms of the island behind, the truth was that Abe, like Ruth, was an islander through and through. They both loved the lush verdancy of the peninsula, the relative lack of traffic or suburban sprawl (though that was changing), and had learned to appreciate the four seasons: fall, fall, fall, and winter.
It was a good thing Ruth had insisted they leave the house early, because traffic was slow with the construction on 305. Not that being late would have mattered, since Dr. Jin kept them waiting for fifteen minutes in the examination room, where the two of them sat in uneasy silence, Abe clutching Ruth’s hand in solidarity.
When Dr. Jin finally made her entrance, it was impossible to gauge from her manner whether the news was good or bad.
“Mr. and Mrs. Winter, hello,” she said, and wasted no more time on pretense. “Your pathology report came back from the lab, Ruth. Unfortunately, it’s not the news we’d hoped for. The mass is…not benign.”
Dr. Jin gave them the briefest of moments to process the diagnosis.
“The good news,” she said, “is that the growth is relatively isolated at this point to the bone, and the margins appear to be clean.”
Everything after “not benign” washed right over Ruth as her ears began ringing. For an instant, she thought she might faint from the shock of the news.
“So, you’re saying she has cancer?” said Abe.
“Yes,” said Dr. Jin.
Again, Dr. Jin granted them a moment to consider the pronouncement.
“What now?” said Ruth, as though from some great distance.
“This calls for aggressive measures,” said Dr. Jin. “We need to act quickly. I’m going to refer you to a surgeon, Drew McGonagle at Swedish, one of the very best in the business.”
“Just how serious is this?” said Abe.
“We won’t really know the full extent of it until Drew gets in there and has a look during the surgery. There’s only so much we can glean from the imaging. But it’s clear the mass is attacking the bone.”
“So, they cut the mass out?” said Abe.
“Yes,” said Dr. Jin. “We’re talking about considerable bone loss, as well, a large portion of the lower jaw, along with some teeth, and possibly the lymph nodes. We don’t know if the tongue has been compromised, or to what extent, nor the surrounding soft tissue.”
All the air seemed to vacate the room at once. Ruth could scarcely breathe. Strangely, Dr. Jin’s grim assessment of her situation had served to mobilize Ruth’s vanity in almost equal measure to her fear of her mortal demise. The prospect of walking around with a stove-in face on the right side, of losing her tongue and mumbling the remainder of her days so no one could understand her, the probability of losing her hair—each of these considerations was hitting her at once, and nearly as terrifying as death itself.
“And then what?” said Ruth. “Are we talking about chemotherapy, here? My hair falls out, I wither away to skin and bones? Honestly, I don’t know if I could take it.”
“Let’s just get you through the surgery first,” said Dr. Jin. “I’m not going to lie to you, Ruth. This is going to be a major ordeal, some really rough sledding. But there’s a good chance we can eradicate the cancer.”
“Is there another option?” she said.
“You could choose not to treat it.”
“And?”
“You’re probably looking at hospice in four to six months.”
“Jesus,” said Abe.
“What’s the timeline for a surgery?” said Ruth.
“As soon as possible,” said Dr. Jin. “Three weeks tops.”
On the way home, they drove in silence for a mile or two, Ruth gazing passively out the passenger window at the rash of recent construction spreading before her eyes. How could it be that she was so close to death at that moment, and yet, excepting a loose tooth, she felt perfectly fine? Had she just let the thing rattle around in the back of her mouth or fall out on its own, she might have been dead in four months. And she still might be. Who was to say she’d survive the surgery, or the radiation, at her age? What if the cancer had already migrated elsewhere and Dr. Jin had no way of knowing? It could be anywhere in her body right now, eating away at her, attacking her.
For all the anxiety surrounding her own future, Ruth’s thoughts turned to Abe. What would become of him if Ruth went first? Who would take care of him? Anne was half a continent away. Maddie was in Corvallis and could barely take care of herself. It would have to be Kyle, she supposed.
“What about the kids?” said Ruth at last. “Do I even tell them?”
“Of course,” said Abe. “You want me to tell them?”
“No,” said Ruth. “I’ll do it myself.”
She couldn’t say why she called Kyle first, likely because among her three remaining children, he was her optimist, where Anne was the realist and Maddie the skeptic. Like Kyle, Karen, dead at sixteen, had been an optimist, up until her teen years. How many occasions in the past five decades had Ruth missed Karen’s childish optimism, her laughter, her curiosity, her affection? Thank goodness Ruth still had Kyle. She knew she could count on Kyle to remain upbeat upon hearing the news, and he did not disappoint.
“Okay, good, that’s good,” he said as Ruth walked him through the details. “Swedish is top-notch, and not just regionally, globally. You couldn’t be in better hands, Mom. It’s not like forty years ago, when a cancer diagnosis was basically a death warrant. They know how to treat it now. The science has come a long way. I know at least ten people who have beat stage four in the past five years. It’s good they found the mass when they did.”
The call to Kyle managed to buoy her spirits momentarily. Maybe she’d survive this, after all. However, Ruth called Maddie next, who offered an opposing view of the medical prospects.
“You don’t have to let them blast you with radiation, you know? It kills everything, good or bad. Have you thought about alternative medicine?”
“I trust Dr. Jin’s judgment,” said Ruth. “And Swedish has an excellent reputation—and not just regionally, globally.”
“Mom, the surgery and the radiation are worse than the cancer. The medical-industrial complex is a sham. Look into holistic oncology options. I went through it with Rupert,” she said.
“Rupert was a pug, darling. And he died, as I recall.”
“Let me send you some links.”
“No, sweetie, it’s okay. But I’ve heard your input, and I promise I’ll consider it,” Ruth said.
Ruth found herself delaying the call to Anne as long as possible, because she knew Anne would have the most questions and expect the most answers.
“Did you get a second opinion?” she said.
“It’s cancer,” said Ruth. “What good is a second opinion? I have it or I don’t.”
“Your insurance will cover the surgery, but what about rehab? Will your Medicare cover that?”
“Honey, I don’t know all that at this point,” said Ruth.
“Who’s gonna take care of you, Mom? Should I fly out there? I can’t get away until after Thanksgiving, but—”
“No,” said Ruth. “That isn’t necessary. We haven’t even scheduled the surgery yet. And your father is here to take care of me.”
“No offense, Mom, but this is way over Dad’s head. You’re gonna need actual help. Dad isn’t strong enough to help you in and out of bed. He can’t take you to the bathroom. He’s kind of useless at this point, Mom.”
“Don’t talk about your father like that,” said Ruth.
“All I’m trying to say is that it’s too much for you to handle on your own.”
Ruth resisted an urge to take her eldest daughter to task. Why couldn’t she just be supportive like Kyle? Why, like Maddie, must she always be prescriptive? She knew that they both came from a place of caring, but it didn’t make their haranguing any easier to endure. She was exhausted by the time she finally got off the phone. Afterward, she sought out Abe in the living room.
“How’d they take the news?”
“Pretty well, I guess,” said Ruth. “Each one differently, as you might imagine.”
“You okay?” said Abe.
“Yeah,” lied Ruth.
The truth was, she was sick with ambivalence, and dread, and foreboding. And Abe could sense her apprehension. Abe always saw her. Seventy years and counting, and he’d never lost sight of her.
“Sit down,” he said. “Let me get you something to drink. What say we watch a DVD? Or one of those home shows?”
“Yes,” said Ruth. “I’d like that.”