The Post-Birthday World (56 page)

Between suddenly having neither professional nor purchasing power, Ramsey must have felt unmanned. He couldn’t stand having his wife pay for everything, but he had no choice; thus he capitulated to a childlike dependency across the board. Mindful that in many respects she’d been acting like a little princess, now Irina did everything. She gave the housekeeper notice, and once-overed the house from top to bottom herself. When she announced that they were not, end of story, eating out, and further that the ashram routine was out the window, he didn’t put up resistance. Yet the new regime did require her to cook every meal, and, since she was choosy about ingredients, to do most of the shopping. All of which put her behind on the new illustrations, their only immediate prospect of income. So helpless had Ramsey become that he wouldn’t even go to the appointment with his new GP by himself, though it was only a standard checkup. The GP was bound to certify him as fit as a fiddle, but at least an official verdict that there was nothing wrong with him would oblige Ramsey to stifle the bellyaching when they had bigger problems right now than his imaginary disorders.

Sitting in the stark waiting room of their local East End clinic, Irina surveyed the other patients—Bangladeshis on one side, whites on the other, the latter either gaunt or overweight. Indigenous East Enders gawked back; nods and elbows in adjacent sides signaled recognition of their local snooker star. She hated being a snob, but it was hard not to share the locals’ dismay that the man who graced their television screens several times a year obtained his medical care from the grotty old National Health Service along with everyone else.

His name came up, and she told him to be brave, already sounding like his mother. Ramsey hated having blood drawn; well, who didn’t. With a little wave, he disappeared down the pea-green hall, and she had an odd, momentary presentiment of waving good-bye, not to Ramsey for a few minutes, but to a taking for granted of something beautifully unconscious and simple that might never walk back into the waiting room again. Studying the digital readout advising patients to be sure to tell their doctors when treatments actually worked in order to “keep up morale,” Irina cursed herself for not having brought a book.

He was gone a long time. When he finally returned, shirt cuffs unbuttoned, leather jacket in hand trailing a sleeve on the floor, Ramsey wore an expression whose particular shade of seriousness she had never seen before. She’d sometimes given him a hard time about being such a whinger. But with that look on his face, Irina was reminded of the glib 60s graffiti, even paranoids have real enemies. The corollary stood to reason that even hypochondriacs get sick.

“I’d thought you weren’t attracted to me anymore,” she said.

They’d instinctively descended to the basement snooker hall, where Ramsey felt most at home. Yet they huddled on the leather sofa with an incongruous refugee quality, like asylum seekers in their own house. Beneath the conical light over the snooker table, the baize glowed once more like a verdant pasture for a picnic, but it had more the look of grass that’s greener on the other side. The field lay physically before them, but the serenity it vivified belonged to the past.

“But it’s that you can’t, isn’t it? Why didn’t you tell me?” All this time it was what Ramsey

hadn’t
been complaining about that should have concerned her.

“Figured it might get better, like. And I were scared.”

“Denial’s not just a river in Egypt?” The hackneyed wisecrack wasn’t funny; already, jokes came hard. Even Ramsey’s
It’s my prostrate
—he was not that illiterate; he knew the difference—had fallen flat.

“It seems so unfair,” she said. “Why couldn’t it be a little patch of something suspicious on your shoulder blade? It’s as if someone up there is gunning for us. Hitting literally

below the belt.
”

“Can’t say I ever been persuaded that you always kill the thing you love, but sure as fuck somebody’s going to.”

“But it’s not definite. You need more tests.”
“Yeah,” he said hopelessly. “But when that Paki stuck his finger up my bum, his face went queer. Geezer didn’t look happy.”
“You shouldn’t call him a Paki, I guess,” she said dully. It wasn’t
attractive,
but the large numbers of Third World doctors that now stocked the NHS drew universal mistrust, on the arguably unfounded presumption that they weren’t well trained. “When do the lab results come in?”
“Dunno.”
“Meantime, how are we going to do anything? I can’t imagine making dinner, and not only tonight, but ever. Eventually we’ll starve. And forget drawing dopey little pictures. How do people manage in such circumstances? How is it that you don’t trip over hundreds of people on any given day who’ve simply flopped down on the sidewalk? There’s your
prostrate cancer.
” Suddenly a door had opened onto the anguish that had surrounded every side of this charmed house for years, and she realized that until now her life had been exceptionally pleasant. It would have been nice to notice.

Irina recovered her culinary powers—in fact, she was so anxious to do for Ramsey that he objected she was going to make him fat—and otherwise occupied much of the next several days reading medical pages on the Internet. The upside of this research was that it gave her something to do, the downside that it made her sick.

The assertion on each of these Web sites that virtually every man will come down with some form of prostate cancer sooner or later was reassuring, though just because the malady was common shouldn’t make it ipso facto any more palatable. Every therapy described, and they were legion, posted encouraging success rates, but also a list of possible side effects. Though these varied in specifics and severity, a pattern began to emerge: pelvic pain, mild urinary urgency, scrotal swelling,

impotence.
Infection around incision, postoperative bleeding, incontinence,
impotence.
Blood in urine, burning sensation in lower scrotum, difficulty in urination,
impotence.
Diarrhea, rectal irritation, nausea,
impotence.

It would not do to feel sorry for herself, though she hoped it was not reprehensible that she might feel sorry for Ramsey and Irina the couple. In the days she was agonizing over whether to part with Lawrence, she’d thought a lot about sex, about whether it was important. In choosing Ramsey, she had clearly concluded that sex was

very
important. Now it was time to revisit the question, and for the sake of her husband, herself, and their future happiness try to conclude instead that they could live without it.

Well, of course they could live without it. Despite the great cultural to-do over the matter, it didn’t take very long, did it; it didn’t occupy much of the day. Its gratification was fleeting. It was merely an exercise in putting one thing inside of another, and a woman could experience the same sensation, more or less, by other means. As for emotional deprivation, maybe she’d have been more anguished if something along the lines of Alex Higgins’s throat cancer prevented them from kissing. She could still fall into his mouth like sky-diving in the dark; they could still interlock into an inscrutable coffee-table puzzle in the morning. They could still dine together (if no longer in a restaurant . . . ), and hold hands on the way to the cinema. Ramsey was no less handsome, and she would still melt unexpectedly when glancing across the rim of her coffee cup. Why, veritably all of life’s smorgasbord was still spread before them, and to fixate on the removal of one tasty dish from the table seemed churlish in the extreme.

Be that as it may . . . if fucking didn’t take very long, something about the diversion benefited the rest of the day. While she was resourceful enough to counterfeit the sensation, she didn’t

want
it by other means. Indeed, when Ramsey moved to pleasure her these nights, she gently dissuaded his hand, for the prospect of getting off while her husband stayed put was no more appealing than the idea of going on a romantic island holiday all by herself and sending postcards. Since his checkup, even kissing had subtly transformed. Oh, any number of times of an afternoon she was accustomed to reaching for his lips and going no farther. Yet now kissing was a reminder of constraint—not of what they might do, but of what they could not. Even in private, Irina installed a moratorium. Cat’saway shenanigans in her studio while Ramsey made runs to Safeway suddenly seemed like cheating, like sneaking bars of chocolate when your spouse was on a diet. If Ramsey was doing without, Irina would do without. In all, it was a small sacrifice—wasn’t it? It should have been. It really should have been. Alas, the fact that it should have been didn’t mean it was.

Yet while any wife would naturally ponder the matter, the intensity with which she brooded over the prospect of everlasting celibacy was suspect. Perhaps she seized on her husband’s incapacity in bed to distract her from what could prove another pending impotence, of a more ultimate sort.

“Of course, it’s natural for your imagination to run away with you,” said Irina as they walked to the clinic to which Ramsey had at last been summoned. “But most of what I’ve read on these Web pages has been comforting. Even if you have it, so long as it’s at a reasonably early stage, the chances of a complete recovery are high. They’ve come a long way with this stuff, and there’s a huge range of different treatments. Granted, they all come with a little—discomfort—but most of that is temporary.”

“Most of that,”
said Ramsey, who’d not come near the computer. “What bit ain’t temporary?”
The, ah,
pattern
that Irina had detected in sets of side effects she had kept to herself. “There’s really no point in talking about this until we’re sure that anything is wrong.”
“But you was just talking about it.”
“I’m nervous. Motor-mouthing. It’s not helpful, I’m sorry.”
Cherry blossoms in bloom, Victoria Park was viciously beautiful. Clasped in her own, Ramsey’s hand, usually so dry from cue chalk, was sweating. “Irina,” he said softly, “they’re pretty much gonna cut my dick off. Ain’t that right?”
“Shh.”
As they sat again in the waiting room, Irina was mystified why she had ever been anxious about anything else. She marveled how she could ever have worried whether Ramsey would win a mere snooker match, or have lost ten minutes’ sleep over a cheap bauble like the Lewis Carroll. It was inconceivable that she had repeatedly dithered over an editor’s reaction to a few inconsequent drawings, and the fact that she had devoted an iota of concern to whether a stain came out in the wash seemed beyond preposterous, indeed profane. But then, maybe none of that had ever qualified as
anxiety.
Maybe in the end choosing the wrong color blue for a backdrop, losing checks in the post, and dropping an irreplaceable button from your favorite shirt down a storm drain were all just forms of entertainment.
Once they seated themselves before the Asian’s desk—who wasn’t Pakistani after all, but Indian—Irina didn’t like it that Dr. Saleh spent a long moment looking down at Ramsey’s file before raising his head. She didn’t like it one bit.
“Mr. Acton,” the small brown man began. “I am referring you to an oncologist at Guy’s and St. Thomas’s.”
“Excuse me,” said Irina, flushed with fury. “Is that your idea of how to tell my husband that he has cancer? That he’s being ‘referred to an
oncologist
’?”
“It is one way,” Dr. Saleh said warily.
“Ramsey is a snooker player. I doubt he even knows that word!”
“Mrs. Acton,” he said quietly. “I am not the enemy.”
“I’m sorry,” she said. But she wanted to stay angry. As soon as she let go of the rage she started to cry.
Remaining stoical, Ramsey stroked her hair. Bankruptcy may have inspired him to childishness, but the likelihood of major illness had had the opposite effect. Since his checkup, he had been somber, serious, and adult. “But you can tell us something,” he said;
summat,
even his pronunciation made her ache. “You ain’t going to shift us to some other bloke and keep shtum.”
“Your PSA test indicates highly elevated prostatic acid in your blood. Your oncologist will order more tests to establish to what extent—but your urine test did not turn up an alternative explanation for these results. So it is very likely that the malignancy has metastasized. . . . You
are
familiar with this word?”
“You mean it’s probably in the lymph nodes,” Irina intervened heavily. “Or even in the bones. You mean this may be stage three. Or even four. Already.”
“We must not leap to conclusions without more tests. But this is a possibility, yes.” He remembered to add, “I am very sorry.”
“What about the biopsy?” asked Irina; taking charge had become a habit. “What’s the Gleason grade?”
The doctor’s head tilted. “You have been reading about this subject, madam?”
Irina shrugged. “Internet . . .” She had no idea if medical folks were exasperated by the overnight online experts barging into their offices, confident that they know more than GPs, or if doctors were grateful not to have to explain everything from scratch.
In any event, professionals often take refuge in plain fact, and the doctor’s answer was unadorned. “The Gleason grade is five.”
Irina slumped, gut-punched.
“What’s that, pet?”
She kicked herself for not bringing Ramsey up to speed before this appointment. But she hadn’t wanted to frighten him. And she hadn’t wanted any of this to be true. “It means,” she said, trailing a finger along the tender skin at the corner of his eye, “that the cancer is very aggressive.”
“Well, the scale’s one to ten, innit? Five can’t be that shite.”
“No, sweetheart,” she said with a broken smile. “The scale is one to five.”
“So you can see why it is very important that you act on this referral immediately,” said Dr. Saleh.
“I know that this isn’t your job,” said Irina, who had gone from belligerent to beseeching in the course of five minutes. “But could you give us some idea of the kind of therapy an oncologist is apt to recommend?” “Cryotherapy—”
“We’ve tried that,” she said wryly. “It isn’t working.”
Blank. Foreigner. Didn’t get it. “Both cryotherapy and brachytherapy are only options if the cancer has not spread much beyond the prostate. If a lymph-node biopsy is positive, a prostatectomy will not be recommended, either.”
Irina felt a stab of stupid, selfish relief. The chances of permanent impotence following a radical prostatectomy were 80 percent.
“Hormone therapy, radiation, chemotherapy, perhaps some combination. Your doctor will decide.”
Someone had to ask this, and she admired him for daring to bring it up. “Meanwhile,” asked Ramsey, “what about shagging?”
“You will not harm yourself, ” said Dr. Saleh carefully, “if you find that you are able.”
“I realize it doesn’t matter now,” said Irina. “But is there any reason? Something he did wrong? Ramsey’s a little young, isn’t he? Statistically?” Too late she caught herself; if she was fishing for smoking as a catalyst, the impulse was to blame Ramsey, which was not very nice.
“Statistics are a general guide only. In medicine, all things happen under the sun. Or in this case,” Saleh said, and made his one attempt at a joke, “perhaps not under the sun. It is not proven for certain, but there does seem to be a link between increased rates of prostate cancer and lack of vitamin D.”
Forcing a smile, she stroked Ramsey’s cheek, still milky from a life indoors. “Too much snooker, then?”
“No such thing, pet.” They rose to leave.