Her skin is the color of milk-tea but Anusha wears it like an embarrassing birthmark that covers her entire body. She walks slightly hunched, her shoulders rounded and, these days, often with her arms crossed against her chest, as if she’s bracing against a cold, north wind. It started when Anusha had a drainage tube attached to her chest wall and the slightest movement made her wince. Or maybe it started earlier, when under anesthesia she folded her arms across her breasts—or so she imagines—a way of saying, “don’t cut me.” Or earlier still. When she left Kurunegala as a little girl and never learned how to love American winters. She never stopped feeling cold.
She often worried that, at any moment, the prosthesis might slip out of the pocket in her bra and land at her feet like a defrosted chicken breast. But today she has to worry about something else more important, her monthly checkup.
She looks at the clock on her microwave: 8:07. She has time before her 11:00 appointment. No need to rush. She notices more light coming through the kitchen window now that they’ve chopped the tops off the jacaranda trees. It’s criminal what they do here: water, fertilize, chop, hack. A farmer in Sri Lanka would be in heaven if he had this soil, this fertilizer, this water, this sun.
Once, driving in Tustin with her mother, Anusha watched a team of workmen destroying one of the last remaining orange groves in Orange County. When her mother saw uprooted orange trees on the roadside still bursting with fruit, she sighed, “Oh, it’s like seeing a dead elephant. My heart breaks.” A sturdy line of eucalyptus trees protected the remaining orchards from frost and the Santa Ana winds. And beyond it were developments, tract housing all painted peach with terra cotta roof tiles, all identical. The repetition was maddening. Peach, she decided, was the color of fear.
But she is part of it. Anusha’s one-bedroom apartment, where she moved right after she got her first job, is in one of those peach buildings. And she reminds herself of this as she gets into her car. She can see her kitchen window from the outside and on the windowsill is a dead plant, a croton.
Anusha had bought this plant because its deep fuchsia, yellow, and green batik-speckled leaves reminded her of Sri Lanka. When her father had died suddenly of a heart attack, she had left for Wisconsin. Weeks later when she came back all her plants, including the croton, were dead. The only living things were two large black flies, big as bumblebees. She watered the croton and gave it a few drops of Miracle-Gro and said to herself, if this thing grows, if its leaves bud out, then there is a God.
Day after day, Anusha had watered and watched. She was hopeful, because she had seen forgotten potatoes sprout in her cupboard, tender green blades shoot out from meshed plastic bags that held soft, rotting onions. Even carrots had grown tiny leaves in the inhospitable climate of her refrigerator. But the croton stayed as black as the soil it was planted in. She continued to look after the plant in her kitchen window, searching for some signs of life. Then, after two weeks, she gave up.
After signing in on the clipboard for her appointment with Dr. Erwin, Anusha notices her file on the receptionist’s desk and asks if she may please read it. “Sure, no problem,” the receptionist says and hands it to her. She sits by the fish tank of yellow-and-blue striped Emperor angelfish and studies the thick manila file that is all about her: microscopically, pathologically, surgically, medically.
It is like her cancer horoscope but more than that; it is empirical. Her first pathology report begins, “The specimen labeled ‘left breast’ consists of a diamond-shaped piece of skin and breast tissue weighing 300 grams.”
Anusha wonders about her tumor and how it grew. She imagines her breast was like an oyster, with soft liquidy tissue that caught sand and irritants and sadness and grew a hardened mass over time. But rather than a pearl, what it created looked like the gray firm yolk you find in an over-boiled egg.
She continues to leaf through the pages and finds a Christmas card from her to Dr. Erwin that is date-stamped, hole-punched, and two-pronged inside.
“Anusha!” exclaims her oncology nurse. “You shouldn’t be reading that.”
Kathy had always been there to rescue her. She was the first one to tell her to buy a Thomas Guide so she wouldn’t lose her way from Irvine to Orange, where the UC Irvine Medical Center was located. When the phlebotomists couldn’t find her veins, they would call Kathy, who would traverse the campus to find Anusha and draw her blood. Kathy would tell the folks in the blood lab that Anusha’s veins were very shallow, not to go in too deep, to use a pediatric needle and tube. Anusha wonders now if Kathy was trying to protect her from her prognosis.
When she doesn’t hand over the file, Kathy very kindly, though forcefully, takes it from her. She’s stocky with the strength that comes from lifting patients out of bed. With Buddy Holly glasses and short brown hair framing her face, she seems a little amused by their gentle tug of war and by Anusha’s curiosity.
“Why can’t I read it?” Anusha asks.
“Because you need someone like me to walk you through it. So you understand it. It’s not written for patients. Okay? I’ve gotta go, now, hon,” she says, and disappears down the hallway with the file.
Anusha wasn’t sure if Kathy was being sincere. There must have been something in her records that she didn’t want Anusha to see.
When she’s called from the waiting room to the private exam room, she changes into a hospital gown. Her mastectomy bra, weighed down by theprosthesis, hangs like a carcass from the hook on the door. With nothing to read, she looks at herself in the mirror. Her hair has gone from black and wavy to nothing at all, from soft fuzz to ringlets that measure about an inch when she pulls them straight with her fingers. When she was bald she felt like a novitiate Buddhist monk who didn’t have a reason to look in the mirror. Now, she does. She is a different person, even at the cellular level. She looks at her arms, which need lotion, and checks for body odor. After the surgery, she stopped using antiperspirant. It is one of her unproven theories: chemicals that stop perspiration probably cause cancer.
“Come in,” she says, when she hears a soft knock on the door. Dr. Erwin walks in holding her file.
“Hi. How are you?” he asks in a gentle monotone. He’s chubby and his placid blue eyes look small behind round wire-framed glasses. Anusha learned from the university magazine that his father was a plumber.
She hadn’t planned on saying anything but seeing that empathic face, the unhurried manner, her eyes glaze with tears. “My father died last month,” Anusha says, tears rolling down her cheeks. For some reason, more tears fall from her right eye than from the left. It’s as if the left side is too stoic, too valiant to take more onslaughts, the slash of surgery, the burn of radiation.
Dr. Erwin walks over and picks up the box of tissues and hands it to her. It’s her invitation to cry into each tissue. And she does.
“I’m sorry. That’s a lot for you. How old was he?”
“Fifty-five,” Anusha says. “He was a doctor, too.”
“Oh, yeah? What kind?”
“A psychiatrist at a county hospital.”
Dr. Erwin looks at her and she looks at him, and she knows he has a waiting room full of patients and they need to get on with this. Anusha usually cries in the car on the way to the appointment or in the parking lot. Even though she knows there’s not going to be any pain here beyond the discomfort of filling two test tubes with blood, the very idea that this disease might be dormant in her cells, written into the molecules of her DNA, scares her. That next month it might be her other breast and then an ovary and then her bones. And what about her blood? Until there’s nothing left of her to give and she dies in hospice not even valuable to those who harvest organs.
Anusha once met a woman in a waiting room who had cancer of the vulva. She had asked her where her cancer was because that’s what cancer patients do: they let it all hang out. She had asked her to repeat it because she had never heard of vulvar cancer. Even though she understood the words, she couldn’t put them together. The woman seemed a little embarrassed having to explain “lips of the vagina” to Anusha, who thought, Christ, doesn’t cancer have the decency to go someplace less intimate?
Anusha wipes her eyes, her nose. She notices she’s slouching again. She triesto regain composure by inhaling deeply through her nose, arching her neck, and sitting up straight. She feels a few inches taller, a bit stronger. Dr. Erwin puts his stethoscope on her back and asks her to breathe as he listens to her lungs, then moves to her heart. She knows the routine. She slips off her hospital gown and lies down on the table as he examines her left chest wall. She raises her left arm so he can check her underarm, which feels even more hollow without her lymph nodes.
The diagonal scar marking where Anusha’s breast was cut has stretched over the year from a slender pencil line into the shape of a willow leaf. You can still see the tiny blue dots where she was tattooed to mark the radiation fields, and the burns they left behind. The round scars below her ribs mark where the surgeon attached plastic tubing to drain the yellow water from her chest.
Dr. Erwin then examines her right side. There’s something holy and healing about what he’s doing. He presses the breast in concentric circles and feels the hollow of her underarm for things she may have missed. Anusha feels safe, like he’s laying his hands on her.
He orders a mammogram and a chest x-ray, and gives her a prescription to refill her Tamoxifen. Her father was excited about this experimental drug when they first prescribed it to her, thinking this new drug would save her. The cameo of a woman is imprinted on each tiny pill. It gives her hot flashes. She’s twenty-three now and she needs to stay on it until she’s twenty-seven.
When Anusha was first diagnosed, she would have sacrificed anything to live. She told the surgeon she would have a double mastectomy, even though she didn’t need one. Now, she struggles between wanting to die, wishing she would die, and fearing that ordinary things in her life might fuel the growth of cancer cells. Things like the artificial food color Blue Lake #4 or the hormones they give dairy cows. Other times she feels an earthquake or a car crash will get her.
These thoughts make her clench her jaw and sometimes shut down, go blank, sit in a frozen state between fight and flight. She gets a strange sense of peace when she sits still like this, as if she’s inside the eye of a hurricane rather than being in its path.
This state of mind reminds her of a poet whose reading she attended. The poet was skeletally thin and talked about how she had been reading cookbooks as of late. She is like me, Anusha thinks. I read cancer survival self-help books while secretly wanting to die.
For a long time, during her first moments of waking each morning, without raising her head from her pillow, she would bend her chin to her chest and look at its flatness. She confirmed each morning that it wasn’t a dream; she had been amputated. After her father died, that reflexive ritual was replaced with the thought, “Thathi’s dead.” And when Anusha had a lot of stress at the ad agency, the mantra “I want to resign” sometimes became “I want to die.”
Anusha’s father had died on a tennis court in Oshkosh, the small Wisconsin town where she grew up. She knows that his heart failure was immediate but she wondered if the men with whom he was playing acted quickly. She onlyremembers one of them coming to the funeral. He had silver hair and wore an expensive trench coat and told her, “I was with your father. We were playing tennis—I’m sorry.”
She wonders who else was with him when he took his last breath. She never asked the man in the trench coat who they were, how it happened, or if he was winning. Anusha was in shock and there was so much to do. When she sees tennis courts now, she sees the white lines that mark the alley, the service boxes and the service line, and she imagines a white curved line around a collapsed body.
She will pick up the Tamoxifen but will schedule the mammogram and the chest x-ray later. She needs to get back to the office. She sees her reflection on the glass doors as she walks out. Hunched. She straightens her spine, but by the time she reaches the parking lot and sees her reflection in the car window, her back is curved again. She sees the Thomas Guide on the passenger seat and remembers what Kathy had said. When you look at the pages and all the detail, the streets, it’s all like spaghetti. So look for the big streets, your markers. So Anusha thinks that will also apply to her life. Make it to the mammogram, and then the bone scan, and then the five-year mark. And everything else will be little streets.
Chelika Yapa received her MFA in Creative Writing from Boston University, where she was awarded a Robert Pinsky Global Fellowship. Her personal essays have appeared in Glamour, Mamm, and Now. “Follow-Up” is her first published fiction, drawn from the experience of having been diagnosed with breast cancer at the age of twenty-two. She is grateful to her writing instructor, Lou Mathews, for his friendship and support.