The Cruel Country

Notebook One

1 The black word: el cáncer

I am headed to the west coast of our tiny island, toward my mother, who has been hospitalized with a mysterious combination of symptoms that include tachycardia, respiratory distress, and trembling—symptoms she’s had before, but this time they are uncontrollable. The sound of the black word still tastes bitter on my tongue: cancer. El cáncer. The cousin of mine with the best grasp of English in the family had been assigned the task of calling and e-mailing me, as everyone assumed I’d need some words of explanation in English. El cáncer, however, is a cognate, pronounced almost exactly the same in both tongues. It creates a vacuum in both languages, a sinkhole.

I take an avioneta from San Juan to Mayagüez. The eight-passenger propeller plane is not big enough to even qualify as a small plane; the diminutive avioneta as opposed to avión, airplane, implies its minuscule size, smaller-than-small—advance notice to all potential occupants who will be suspended above the earth in an (almost) toy-sized plane. The pilot’s elbow hangs out of his open window, like a driver’s before the advent of signal lights, as we taxi down the runway. I get the impression that this maneuver is somehow necessary to lifting us off the ground. Or maybe he’s just showing off. My seat is so close behind the pilot’s that I can see the sweat on his neck and the reflection of the burning tropical sun on his shaved head.

My first response to the news, after I emerged from the initial shock, was anger. Rage at the so-called specialists who found reasons for endless cardiological tests and a CT scan of her abdomen but did not think to check her lungs, although she was a life-long cigarette smoker. When my aunt took the phone after my cousin had run out of words that would satisfy me, she finally said that the primary care physician’s opinion was that my mother had hidden the truth from her family. It appears that my beloved mother, Mami, the inspiration for many of my poems, stories, and essays, had lied so convincingly to her doctors that she managed to evade inspection of the area that would reveal her darkest secret. She had claimed and proclaimed to have cut back on her smoking, to have nearly quit. I had occasionally caught her with a cigarette when I visited her on the Island, but it was always I’m down to two a day, Hija. And always she’d repeat the old stories of her father, mother-in-law, and other relatives who had lived as smokers to a great old age. I lectured, questioned, and cajoled, but because we lived so far apart and always had so much else to discuss during our phone conversations—our talks were filled with news of my daughter, the granddaughter whom she adored, and my new grandson, her great-grandchild, whom, it turned out, she’d never get to meet—that I was unable to see the truth.

The avioneta rounds the Island at such low altitude that I get to see the Island’s full natural beauty from the vantage point of a seabird. I look beyond the huge tracts of houses, the great metropolitan spread of San Juan, and focus on the stunning turquoise of the seashore and, ahead, mountains so lush that in spite of the weight of the word cancer growing in my chest cavity, the poisonous taste of it on my tongue, and the bubble of sobs on the verge of choking me, I let out a mighty sigh. A Puerto Rican sigh. Loud enough that the pilot hears it above the propeller’s noise and turns around to wink at me. Quite a sight, huh? He’s American and younger than I imagined from the gray shadow of hair on his shaved head. He is earning his wings on these taxi rides across my country, I heard him tell the shotgun seat passenger. Yes, it’s beautiful, I reply and he smiles again at the emotion in my voice. I can practically hear his thoughts: These mainland Puerto Ricans are a sentimental lot about this crazy place. They should try living here for a while. Or maybe I’m just projecting. At this moment, still distanced, flying above my mother’s island, I have no idea that I will soon be trying to do just that, to live in this foreign land that is my native country, while also learning to separate myself from all that has ever connected me to it—my mother.

2

Before my trip, while still in the peaceful setting of our home in the Georgia countryside, I made a plan for getting her the best care possible. I downloaded several e-books to my iPad, including Cancer Caregiving A-to-Z and The Emperor of All Maladies: A Biography of Cancer. During the long days and nights sitting by my mother’s hospital bed, and afterward, only a total immersion in words and scientific facts will keep me from drowning as the shoreline recedes from view.

The hospital, La Inmaculada Concepción, has the appearance and ambience of a Catholic chapel, with a large statue of Mary in front and blue-and-white-toned décor punctuated by murals and portraits of a peaceful-looking and apparently hopeful Holy Family: the Holy Family before they knew what was coming; before torment, pain, and death; before Calvary.

I have already been to the Island to visit my mother twice this year because she’d been experiencing a decline in her health. Tiny to begin with, not quite five feet tall and never weighing more than 112 pounds, she was down to only 98. No appetite, a grayish pallor over her honey-colored skin. Alarmed by her sickly appearance and unusual lethargy, I had accompanied her and her husband, Ángel, from specialist to specialist, arguing in my basic-to-weak Spanish (weaker as the vocabulary for her symptoms and treatment got more technical) with bureaucrats who refused one doctor’s request of a CT scan of her abdomen without signatures from several other doctors who had insisted on return appointments weeks in the future. Finally, she got the scan and we got some answers: she had stones in her bile duct, which could be pulverized with a laser! With this good news, I finally left the Island, flying out of the warmth into two winter storms, one at my Newark connection and another, a rare southern snowstorm, in Atlanta. I managed to get home just as everything was shutting down. I felt good about having helped my mother and felt even better, after her endoscopy was over, hearing her tell me over the phone in her familiar, strong voice that she was eating again. In the next few months her recovery seemed real enough. She claimed to be almost back to her usual busy schedule of church and civic activities and the endless round of celebrations that is common in a family the size of hers, with seven out of eight living brothers and sisters and all the related baptisms, birthdays, and anniversaries that had to be marked with fiestas. Not as much dancing as before, she admitted, but she was on her way.

Along with the other two books, I also downloaded a Spanish-English dictionary and looked up the translations for certain key words: quimioterapia, decaída de salud, and cuidado en un hospicio. I’ve practiced the pronunciations. I recall one of the things my mother often complained about during the many years of what she always called her exilio in the United States as a navy wife, before she returned to her Island to live her real life: that when she tried speaking in English, people treated her as if she were stupid. In the eyes and ears of others, her intelligence was indicated by her thick accent, her mispronunciations, and her limited vocabulary. In Spanish, however, she was a powerful woman. All during her last year, I heard how her voice weakened, how words began to be cut off by the little breaks in her breathing that were slowly becoming more pronounced. How could I not have known?

3 Estoy aquí

I enter that other place, the kingdom of the sick, on this white-hot day when the tropical sun seems to be burning a hole in the sky. Last night, at home in Georgia, I lay awake, trying to imagine my mother as she must now be, so ill that she could not speak to me on the phone. This has never happened before in the long history of our separation. Her voice has been a constant in my life during all manner of crises on either side of the Atlantic.

I’d heard many other voices the night before. Ángel’s voice was hardly understandable, it was so low on the voicemail message, saying hesitantly in Spanish that he thought I should come to her. She had been asking for my brother and me but was very weak. My oldest uncle advised me in a stronger voice to come soon and to let my brother know that she estaba muy malita, the diminutive used when you want to avoid saying gravely ill. The cousin who knows English repeated their messages to make sure I understood the situation. But she too said muy malita in Spanish, unable to come up with the equivalent words in English. I know that much about the dialect—the worse the situation gets, the littler everything becomes, almost baby talk: Tu mami está muy malita. Not muy mal, very bad, but a little bit very bad.

Susan Sontag has called illness the night side of life and said that we enter the kingdom of the sick as citizens with a dual passport. On June 30, 2011, I walk into the place where my mother will die fully experiencing what I used to think of as a cliché, a sinking heart, but someone long ago got it right. There is no better way to express that physiological plunge, much like the sensation I feel when the avioneta from San Juan begins its descent—a sinking of all my inner organs, a need to take deep breaths, the sensation of vertigo at the approaching downfall, the landscape turning and turning. I am going to be okay, I tell myself, but as soon as my aunt reaches for me in the lobby of La Concepción, I collapse into her arms. She and my uncle let me empty my chest of the sobs I have carried with me as dead weight since the phone call. Then they sit me down in front of the mural of the Holy Family and tell me that I have to prepare myself for what I will see. My mother is on oxygen and an IV for morphine and nutrition, as she is eating less and less every day. She has lost a lot of weight. Her eyes are mostly closed, and she does not remain conscious for long.

Her doctor has shown them her chest X-rays. I insist that my uncle tell me exactly what they saw.

Oscuros con manchas en la placa, he says. Dark with plaque. But I know from the careful way he speaks the words that there had been much more to see in that stark landscape of her lungs.

What can be done, I want to know. Surgery? Chemo? Quimioterapia?

This is something I will have to discuss with the pulmonologist, the oncologist, and her primary care physician.

How did this happen? How could she have gotten so ill so quickly?

Shaking of heads. Then my aunt, carefully, gently, Fanny fumaba mucho.

She smoked. She smoked a lot. No, I say, she had cut down, had almost quit. She told me so herself.

Silence.

The kingdom of the sick is very small and keeps shrinking the longer you stay within its boundaries. There are at least six people around her bed: her four sisters, her sister-in-law, and my oldest uncle. Four or five of her nieces and nephews are in the hallway. No, there are seven people in the room. Ángel, her husband, is in a chair very close to her bed. His head is sunken into his chest, his hand near her hand, which he can’t hold because it has so many tubes attached to it. I am hugged by each of my aunts and then gently, respectfully, by the man who replaced my father over two decades ago. My mother was a widow then, still beautiful in her forties, and had gone back to the Island to reinvent herself as an independent woman who had spent most of her life in the United States. She had kept her Puertoricanness intact, paying for it with loneliness and good-wife servitude. Ángel was divorced, six years her junior, a former minor-league baseball player with Latin-lover poise, dark good looks, and a gentle disposition that matched his name. He had been immediately struck by her sophistication, her intelligence, her wit, and most of all by the fact that she loved to dance as much as he. He was the opposite of my intellectual, taciturn father and perfect as a partner in part two of the narrative my mother was creating for herself. With her Ángel, she began a life so different from her exilio that I drew from it again and again in my poems, essays, and stories. She had taught me something about reinvention and transformation.

My mother was a performance artist; she had re-created herself by sheer will and perseverance. Once a timid immigrant wife who needed her husband and children to lead her through the labyrinth of life on the mainland—a lonely navy wife who read romance novels as she waited for her eventual release from exile—she had made herself into a sassy, bold, and fully engaged woman who had returned to her rightful place in the world. I watched her grow and change with amazement and pride, as if she were my offspring. I recorded in my poems how I saw the light return to her eyes—the light that had been dimmed by her loneliness and the demands of life away from her beloved Island and the support of her extended family, the little fire she had stoked with dreams of eventually returning home. For almost twenty-five years she had managed to keep faith in her dream of return. Over the years of her developing liberation, I observed that although she was involved in politics, charity work, the church, and her large extended family, she expressed her recovery of the best in herself most fluently on the dance floor with her Ángel. In the days and weeks to follow, I will hear from their friends and acquaintances that Fanny and Ángel were dos trompos on the dance floor. Like two spinning tops.

A phrase from Shakespeare comes to mind as I look at my mother lying on her hospital bed with an oxygen mask over her long Roman nose and full lips, gasping so hard for breaths that her thin chest literally jumps at the intake, almost like she wants to wake herself up from a bad dream. Fly away, fly away, breath. I can’t imagine her never getting up from this bed. I will myself to think of her as resting between salsa numbers while the band is taking a break. She is catching her breath.

4 The kingdom of the sick is very cold.

I spend the first night in the hospital room. The family has tried to dissuade me. I have been traveling for twelve hours: I look exhausted. She knows you’re here. Ángel will stay. But Ángel has already been by her side for over a week, ever since I talked her into going to the ER. Her voice had been so weak. The few steps from her rocker to the phone had made her dizzy. For once, she had admitted that she was not feeling very well. She did not say, Estoy malita, which would have alarmed me even more. She said, No me siento bien hoy. Not feeling well today. I asked to speak to Ángel, who was obviously right by her side, possibly holding her up. He said, Está malita. She is a little bit sick. So sick that words had to be moderated. She began to protest, and I used my translator voice, the commanding voice I had learned to use as a child when I needed to make her see that I knew the situation better than she could; I was the interpreter. If the landlord had said we had to pay the rent this week, it meant this week and not horita. Not the vague sometime soon. If the teacher scheduled a conference for next Monday, in America, it really meant el lunes and not I will see your teacher when your father comes home. She’s not going anywhere, right? The day of her breathlessness, I said, I am going to call you back in thirty minutes. Please be on your way to the clinic. Do you want me to go down there again to make sure you take care of yourself? She had agreed, although she took a shallow breath and said something that seems ominous now but sounded only like a protestation then. She said, I know what they will say. That day, I began the inexorable gallop toward this night in the cold hospital room looking at my mother, no bigger than a child under her favorite pink blanket, which Ángel had brought her, and with her head resting on a pillowcase she had embroidered with multicolored flowers and vines. The embroidery once done for food money by her mother and sisters during the World War II years had become a relaxing, meditative activity for her. She’d called her hours working the intricate patterns on cloth mi terapia, her therapy sessions. I have a shelf in my linen closet stacked with pillowcases, tablecloths, and towels embroidered by her and her sisters. I also keep a treasured tablecloth intricately embroidered by my abuela, now dead for fifteen years. Embroidery was a family female activity. They gathered in the afternoons to sew and talk. In my childhood it was a magical time of eavesdropping on gossip and listening to cuentos that would seed my imagination.

Her hands are swollen from the IVS and she is barely conscious. I lean close to her ear and say, Mami, estoy aquí. I put my hand on her head and stroke her hair, noting that her roots are showing. She has never allowed any gray to show. This gives me a clue to how long she has been really sick—several inches of illness. Like many Island women of her generation she had decided not to go gray by going brownish copper instead; at least her hair was not red like many others’. I had always disliked this trend of older Latinas bleaching and coloring their once-dark hair to emulate the fair-skinned models they saw on TV. In my mind’s eye my mother has ebony black hair, lots of it. It’s hair I inherited, and I am still fighting the urge to let it go gray naturally, but black or gray—never red. Why am I thinking this now?

My mother responds to my touch with a flutter of her eyelids, moves her fingers a little. Keeping my left hand on her head, I take her hand in my right. I look at it. My hand looks more wrinkled and fingers more bent with our family arthritis than hers; the swelling has rejuvenated hers. I speak the words that I will repeat to her until the last breath she takes:

Estoy aquí, Mami.

As people file out at the end of visiting hours, the room grows colder. Crowds of people are the norm in this country. No one seems to require much personal space except for the overworked doctors, who can be seen backing away out of rooms, separating themselves from the anxious relatives who surround the beds of their loved ones and always have a thousand questions. There are always several conversations going on at once; bedside vigils are a sort of social occasion and family reunion for people who may not have had a reason to be in the same room in a while. I notice that there are also a lot of spontaneous group prayers. It is a Catholic hospital where political correctness doesn’t apply—if you don’t want crucifixes in the hallway and a rosary placed by your bedside, go somewhere else. Here even the nurses mouth the words to an Ave María or Padre Nuestro if they have to change an IV during a prayer session, and they always offer a blessing to the patient before they leave the room, Dios la bendiga. As the woman in the bed on the other side of the curtain is being prayed for, Ángel and I wait for the amén before moving or speaking. The prayer leader, who turns out to be an evangelical preacher of another faith, falls silent at the end of his impassioned impromptu sermon to allow the Catholics in the group to conclude with the Act of Faith, the Credo. Creo, creo, creo. I believe, I believe, I believe. He comes over to offer my mother a blessing. We bow our heads to him, offering my mother’s situation to Providence, unless Dios feels she has a greater duty to us on earth. I have an impulse to wake her so I can remind her that she certainly does have a duty yet to fulfill, one of many, but one that is very important to my daughter and me: we want her to meet her biznieto, Tanya’s little boy, given a name that both sides of the family, Spanish- and English-speaking, could pronounce—Elías—so that Mamá Fanny, as Tanya calls her, could say her great-grandson’s name with ease. John and I chose Tanya for the same reason. My father, just learning English when I was born, had insisted on naming me Judith. It comes out Joodit on the Island, or even Hudit, the th sound simply not well managed by Spanish speakers’ tongues. Elias will come to see you next year, Mami, or we will send for you and Ángel, a vacation in Georgia at our home in the country. You love John’s cooking, southern meals made from vegetables grown on our own piece of red soil. And you will fill our home with the smells of your guisados. We will have to go to Augusta to find the right kind of rice and the can of Goya beans—the best we can do for Island foods in Georgia even though they taste of homesickness, of exilio. As you cook on one side of the kitchen, John and Tanya will be making peach something-or-other for dessert. I’ll be trying to help with the menial tasks, and everyone will be teasing me as usual, warning me to stay out of the kitchen since, as the noncook, I have nothing to contribute to the culinary chaos except unsolicited advice.

The temperature continues to drop. I huddle in my hard chair, knees to my chest, arms wrapped around them. Ángel tucks the pink blanket around my mother’s thin body. I can see the violent rise and fall of her chest, each intake followed by a slight gasp. I look up to see what he’s doing as he begins to perform what looks like a familiar ritual. At first I think he is applying medicine to her forehead, but then I see a sticker with a Catholic cross on the little jar he is holding. He dips his thumb in the jar and draws a cross on her forehead while whispering something close to her ear. I see now that he is anointing her with holy water. I don’t know why this makes me break down, but I run into the restroom to cry so as not to frighten her or him. I hear her say, Ángel. And him, Sí, Fanny, sí.

Her hairbrush, her toothbrush, and a jar of Pond’s cold cream are neatly arranged on a shelf in the bathroom. My aunts told me that she had insisted on being helped up to wash and use the toilet a couple of days ago, struggling to walk the few feet from her bed. I could hear that pitito, a little whistle sound like wind through the trees, as she breathed, one aunt said. I did not inquire further about the pitito. I know what my tía was telling me. My mother’s lungs are like a sieve now. I cannot bear to dwell on the painful image.

She had been upset by the insertion of a catheter. She knew it meant that she would not be getting up. I am grateful for the fact that she was already only semiconscious by the time they placed the pad, universally called el pamper here, under her body. What am I saying? I would be grateful to hear her rage against this humiliation. She was always exquisitely private about her body’s functions; I’d hear her turning up the radio in the apartment in Paterson and later in her little house on the Island before she went into the bathroom, ironically announcing what she wanted to conceal. The smell of deodorizers permeated the house. One of the last complaints she’ll have, whispered so that only I can hear, is Tengo que evacuar. Pero no puedo. Evacuar, evacuate—a delicate euphemism, a cognate. She has to but can’t. She is not eating, so there is nothing in her stomach or bowels. It is only as a last measure, during an impending disaster, that one evacuates. Is she punning? I think not, but she loves language, her language, and making a joke or pun out of life’s small miseries is one of her best survival techniques.

Ángel has produced a bedroll and placed it on my chair. He has also put an extra chair borrowed from an empty room in front of mine so I can stretch out. He sits up all night. The next day I begin requesting a sleep chair for him, again and again, of nurses who nod and say, sí, sí, sí, meaning nothing. I ask until I become what I will be for the next week,