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Foreign Bodies

As an ophthalmologist, my father has to deliver bad news fairly often. After thirty years of practicing medicine, he’s learned to expect patients will resist and deny painful diagnoses, so he uses medical terminology—astigmatism, cataracts, macular degeneration—to give people something to hold on to.

I was photocopying insurance cards in his medical clinic when he told an elderly woman that she was legally blind. The woman was shocked. “But I can see fine,” she insisted. She held her daughter’s elbow, sobbing, as they trudged down the hallway to the waiting room. The woman couldn’t see any less than when she had walked into my father’s office.

Recently, he told me about a man who burst into tears when told that his child would need glasses. “But all the kids at school will make fun of him,” the man said. “Maybe we can wait until he’s a little older and bigger.”

With calm, my father answered, “Your child’s vision is blurry. He can’t see the board at school. He can’t see a car coming when he crosses the street.”

*

I’m pressed against the picture window on the seventh floor at Massachusetts Eye and Ear. The Charles River shimmers, and for a weekday morning, there are a surprising number of sailboats gliding in figure eights. It’s a beautiful day at the end of the summer. The kind of day that reminds us to hold on to it before it’s gone, before the autumn forces us to retreat inside.

Ten adults crowd the hospital room, missing meetings and not returning phone calls or emails, so that we can sit around an empty bed. We’re waiting for my two-year-old niece Naomi to return from emergency surgery to remove her right eye.

My mother sits in a plastic chair, counting the hours in rosaries, fingering each bead with a Hail Mary, again and again. My mother prays to her dead parents and siblings, begging them to whisper in God’s ear and intercede on her behalf. Naomi’s other grandparents, a preacher and his wife, whisper softly, an occasional “praise God” rising to my ears. Naomi’s mother, my sister Ann, reads the latest Harry Potter, and Naomi’s father Jorge talks on the phone, telling and retelling the story while we wait.

I notice Jorge is wearing the Superman T-shirt he wore on the day Naomi was born, the one inked with Naomi’s newborn feet. It used to hang inside a box frame on the wall in his study, and I wonder about his decision to wear it. I imagine his loneliness and despair as he unhooks the frame from the wall, unpins the shirt, and pulls it over his head. These small actions are all he can do not to feel entirely helpless.

As soon as he heard the news, my brother Jet took a flight from Maui, traveling across the Pacific and then the continent. My other brother, Gerry, a first-year medical student at Boston University, skips his classes to sit with us. My husband Alonso waits here too. My sister Tessie, who is due to give birth any week now, calls us constantly from Los Angeles.

But there’s a noticeable and puzzling absence: my father, the ophthalmologist. We act as if his absence proves the depth of his love for his granddaughter. He must love Naomi more than any of us, and that’s why he’s not here.

But I know the truth of why my father isn’t here: he blames himself. If Naomi dies because he waited too long before voicing his suspicions about the subtle, almost imperceptible changes to her eye that he was the only one of us in a position to interpret—if Naomi dies because my father didn’t say a word and the cancer eats her brain and spinal cord—I will blame him too.

*

Naomi’s diagnosis took only seconds. The pediatric ophthalmologist just blinked into his ophthalmoscope before announcing, to everyone’s shock, “Tumors. Looks like retinoblastoma.”

And just as quickly, my father, who was in the exam room chatting with his former colleague, spun around and left the room without saying a word.

The team wanted to remove the eye immediately, but they couldn’t schedule surgery until first thing the next day.

My father didn’t speak much for the rest of the day, nor did he leave the car to attend the flurry of appointments with specialists before my niece’s operation the next morning. I was in the car alone with him when he said miserably, “We could lose her.”

“Not lose her,” I countered. “Just her eye.”

“Losing her eye,” he said, “is the least of our worries.”

*

While in training for his ophthalmology specialty thirty years ago at Philippine General Hospital, my father had witnessed enough cases of Rb to fear it. Some of the parents he met had read the mysterious white glow from their toddlers’ eyes as a sign that their child was special, embodied with powers to divine the future or bring the family luck.

“Stupid,” my father said. He watched their children die.

Once Naomi was diagnosed, Ann recalled moments in the past months where she saw a strange reflection from the night light in Naomi’s right eye, like the glow of a cat’s eye. But the conditions had to be just right, and Ann didn’t see it all the time, so it didn’t alarm her.

As the first grandchild in our family, Naomi was the most photographed child in our history. That night after hearing about Naomi’s diagnosis, my father studied hundreds of photos of her. “I didn’t see it,” he said. “How could I not see it?”

Every month since Naomi’s birth, Ann has posed Naomi with a stuffed Tigger and posted these photos to her baby blog. The baby blog meticulously documents “firsts” in Naomi’s life, which, considering she’s just turned two, is almost everything. But the last picture, instead of merely celebrating her growth, showed Naomi’s tumor. In the flash photography, the tumor in her right eye was obvious, unmistakable. Instead of normal red eye reflex, Naomi’s right eye was an opaque pearl. In a handful of other photos from the past four months, there were hints of the white spot in her eye, slight irregularities. There it was while Naomi blew out two birthday candles, while she sat with my father watching television after a summer cookout, while she posed indoors next to Clifford the Big Red Dog on an excursion to Boston’s Children’s Museum.

But clues are not enough. An eye exam in a darkened room with an ophthalmoscope would have caught the gooey tumors as they started to gather and grow. Instead, for months, the cancer cells on her retina spread until they detached her retina, blinding her in that eye, and none of us knew.

*

We didn’t know how much we needed Naomi until she came into our lives. When she was a year old, Ann and my brother-in-law Jorge moved in with my parents to save money for a house. My parents were delighted. For almost a decade after their five children had left the nest, their house had been empty. There were rooms, full of our old clothes, that my parents didn’t enter anymore. The first time I visited my parents’ house after Naomi moved in, I walked up the green carpeted stairs and found one fuzzy pink sock, then a plush rattle. I heard laughter. Effusive. Explosive. Joyous. It had been so long.

Naomi performs daily miracles we can’t live without: She’s thrown open the bulkhead door in the cellar where my father hoards his love. She shines herself at us and says, “I love you.”

During that first year at my parents’ house, one day a week Naomi was mine. I would leave my apartment before 7 a.m. so I could be the first person to greet Naomi when she awoke; it was me who performed the morning rituals of diaper change, warm milk bottle, and snuggling. My name was one of her first words, and her parents taught her to add the Filipino word for aunt, “tita.” As her vocabulary grew, I was Tee Grace, then Tee Tah Grace; and then she sang my name into a birdcall like the northern bobwhite, Tee Ta Grace.

We attended a Mommy and Me-type music class together, and I pretended to be her mommy. The first time I brought her there she was so anxious that she vomited. The next couple of classes she sat on my lap and held my arms around her like a scarf as she watched the other children dance and sing. Then one day, she jumped out of my lap as soon as the teacher began to play the guitar, and before I knew it, Naomi was leading the toddler mosh pit.

That year with Naomi held some of the happiest moments of my life. We threw handfuls of cereal onto the living room floor and let her dog Gordie, a 170-pound presa canario, clean it up. We emptied a container of baby powder in her bedroom when she missed the snow. We tossed pizza dough into the air and cracked eggs against the counter and spooned soil with ice cream scoops into seedling trays on the coffee table. After our day together, I’d feed her and bathe her. I’d rock her on my belly and tell her a story, then continue retelling it until Naomi stopped saying, again, again, again.

*

As the daughter of an ophthalmologist, I was constantly aware of my eyes. The world I knew was riddled with dangers. My father prohibited us from throwing snowballs or eating lollipops or filling out crossword puzzles in the car or letting the dog lick our face. I learned to respect the raw power of drinking straws, metal clothes hangers, baseballs, pencils, and tree branches.

When I started working for my father at age eight, earning a few pennies for each medical chart I completed by pasting in multicolored chart numbers, he told me about foreign bodies. “Foreign bodies—dust, metal shavings, wood chips,” he explained, “prevent people from seeing. Sometimes they make your eye infected, and sometimes they can make you blind.”

I imagined miniature men in ethnic costumes kicking as my father plucked them from the whites of his patients’ eyes.

My father saved up stories from the hospital and transformed them into directives: Never let a parrot sit on your shoulder, I don’t care how well you think you know him. (One of his patients liked to feed her parrot almonds that she balanced on her lips, until the parrot mistook her eye for an almond.) Don’t carry pencils, sharpened end up, in your shirt pocket. Watch out for corners on bookshelves and tabletops, or better yet, only buy furniture with rounded edges. Avoid long-stemmed roses, popsicles, high heel shoes, and hardcover books. No jumping on the bed, look what happened to your brother.

My brother Jet was almost two when he fell from the bed, hitting his eye on the corner of the wooden headboard and falling to the floor. My father carried Jet through the emergency room of his hospital, past the waiting room and nurses’ station. He sat my screaming brother on a bed and pulled the yellow curtain around them. My father didn’t trust the resident on call, didn’t trust anyone but himself to hold the sharp points of the syringe, the threaded needle, and surgical scissors close to Jet’s eye. My mother helped hold my brother down. My father sobbed as he sewed the stitches, but his hand was steady and careful. He understood how a scarred and disfigured eye could impact his son’s future. The pink scar drawn underneath Jet’s left eyebrow is a faded testament to close calls and my father’s expert hands.

But now, with Naomi’s diagnosis, I feel betrayed. I want to tell him, You taught me to be afraid of pens and lollipops and snowballs and rose bushes and everything else in the world when all this time the danger was inside of us.

*

When we tell the story of Naomi’s cancer, my father comes out the hero. It was he who first noticed that Naomi’s right eye was slightly misaligned. During the Easter holidays, I heard him murmuring about strabismus, or lazy eye, and a month later he began to share his suspicions regularly to any of us who would listen. At a Mother’s Day meal, my cousin Rod, also a physician, admitted that he thought Naomi was going cross-eyed.

But despite all the talk, no one was alarmed. We didn’t want to consider that she might be imperfect; we didn’t think her misaligned eyes could threaten anything but her looks. Silent alarms were firing in my father’s head, but he didn’t voice his fears.

Tessie was married that Memorial Day weekend, and all through the festivities my father placed one hand, then the other, in front of Naomi’s eyes. He would sneak his hand around from behind and try to cover Naomi’s eye, but she was a toddler. She would get annoyed and swat it away.

“Leave her alone,” I said. “She doesn’t like that.”

Months later, after Naomi’s cancer was diagnosed, my father, in a story he can’t stop telling, a story that implicates him again and again, tells me that he’d been trying to check Naomi’s visual field. “But she saw my hand,” he says. “She saw it.”

I understand what he needs. Forgiveness, relief from culpability. “You couldn’t have known,” I said. And it’s true. Without a proper exam with the right instruments, he couldn’t have. But I wish he had said, “I doubt it’s anything serious, but I’ve noticed Naomi’s right eye is wandering to the side. It’s my professional recommendation that you take her to a doctor.”

*

The irony is that my father, the ophthalmologist, doesn’t believe in going to the doctor. His medicine cabinet is full of prescriptions he’s written for himself—antibiotics for sore throats and topical creams for his eczema. (At least, he thinks it’s eczema; he’s never been to a dermatologist to find out for sure.) He has health insurance, and plenty of his physician friends would see him for free—that’s not the problem. The problem is that he understands far too well how disease waits for everybody, and part of him still believes that not acknowledging a problem will make it go away.

My father’s not unusual among his friends: cardiologists who smoke and drink, psychiatrists and gynecologists who fall asleep in the middle of a booze-filled weekend mahjong binge. They believe their status and training as doctors makes them unsusceptible to the body’s limits. One colleague, who had two children under the age of six, was covered in bruises and so fatigued that she was crawling up the stairs. The doctors confirmed what she already knew—leukemia—and she was dead in three months. By the time another friend, a psychiatrist, was diagnosed with lung cancer, the only option was palliative care, a pain-free dream he slipped into for a several weeks, and then he was gone. Like them, my doctor father neglects his body, and I have inherited his self-destructive habits: smoking, over- and undereating, over- and underexercising, sitting so still my legs fall asleep, holding my urine until I’m in pain.

*

By summer, all five of my brothers and sisters, their significant others, my parents, and everyone else in my niece’s life weighed in with their opinions: Does she or does she not have a lazy eye?

“Call it amblyopia,” I said. “Lazy is so judgmental.”

Many times, we’d poked fun at people with misaligned eyes: the popcorn vendor at the cinema, the clerks at the town library, the odd colleague with poor social skills. We laughed, “Which eye do we look at when we’re talking to him?” Children are so cruel; adults, even crueler.

Grace and her niece Naomi a year before Naomi is diagnosed with eye cancer. Photo: Alonso Nichols.

In early July, my friend revealed that she had surgery as a toddler to correct her wandering eye. Now her eyes are perfectly aligned, and this information gave me courage to insist. I told my sister, “Get some medical advice about Naomi’s eye from an ophthalmologist who isn’t also her grandfather.”

I was overstepping a line. Never interfere between parent and child. It’s none of my business; her parents know what’s best for her. But for Naomi, I found new courage.

Almost five months had passed from when the question began to form in my father’s mind. The tumors had grown very quickly, and in that time Naomi’s eye became blind. There’s no guarantee doctors could have saved the eye even if they’d found the cancer early, and in a way, finding the cancer at its final stage was a blessing. Now there was no choice but to remove the eye. Maybe if it had been caught earlier, they would have been tempted to save it through radiation or other treatments that can be painful and disfiguring. If the Rb cells had been allowed to escape and tumors were found outside of the eye, Naomi’s survival rate would have dropped to less than ten percent.

*

On the morning before Naomi’s surgery, after Ann and Jorge dress Naomi in the surgical gown, they take a last family photo with Naomi’s right eye. Naomi wears a yellow gown that opens in the back, and thick hospital socks with rough treads on the feet. Her thick curls aren’t brushed, and she’s crying.

After surgery, they will perform scans and biopsies and spinal taps and mine bone marrow. In order to have easy access to Naomi’s vascular system, they hide a plastic port, like a piece of uncooked ziti, under the skin next to her left nipple. They need this easy entrance to her body to infuse her with chemo and test her blood. Her baby-smooth skin is bruised from the needles and raw from bandage adhesive.

After surgery, Naomi does not speak or even cry. Ann lies on the bed and Naomi settles underneath her mother’s breasts as if she’s an enraged squatter trying to move back inside the only home where she ever felt safe. If anyone tries to kiss or touch Naomi or if Ann readjusts her position, Naomi shrieks like a wild animal. She has white bandages over her right eye, protruding like a fist.

Immediately after surgery, we discover that they’ve found no sign of cancer in the other eye, and that on first glance, there are no obvious signs of spreading. All good news.

As we wait for Naomi’s anesthesia to wear off, we sit together in the hospital room and wait. We look out the window so we don’t have to look at each other. We eat soup and drink coffee. We make excuses about why my father, the ophthalmologist, isn’t here for his granddaughter’s eye surgery. We understand that like all of us, he’s doing the best he can.

Grace’s niece Naomi (above) the day after enucleation surgery to remove the eye with cancer and (below) at the same spot more than a decade later.