Double Exposure by Hannah Schultz
Mar 11 ● BY Hannah Schultz
Ever since Anatomy lab my first year of PA school, I can never see my mom’s face when I try to picture her. She’s split open like the cadavers we sliced and analyzed. There on the table is the ballet flat pink squishiness of her brain, the ridges and lobes full of faulty synapses unable to retain memories—birthdays and beach trips and belly laughs on the floor of our basement erased, hard drive lost. Her endometrial tissue seeps out of her womanhood, scarring her organs black before the doctors can neutralize it. And the fleshy redness of her thyroid, never producing enough, never fighting enough. It leaves her muscles weak, skin drained: something is irrevocably missing. I can’t diagnose her myself, but still she’s there, laid out on the metal gurney, each time I think of her—of home.
My dad smiles underneath his 80s-style wire-rimmed glasses and makes small talk on the way home from the airport. My mind is playing games with me. He asks me if I’m going to see any friends while I’m in town, and all I wonder is if he’s glad he sent that text, or if he’s disappointed that he had to dangle it (the inevitable) like a carrot in front of a horse for me to come home—the first time in three years. He asks me how Minneapolis is—how I like my new internal medicine position at the hospital, the weirdest patient I’ve treated since I saw him last, if I know why his knees have been hurting more than usual—and all I can hear is, Why couldn’t you have been a PA in Cincinnati? Why did you leave?
“How’s the weather been?” His voice fills even the briefest silence, swallows it whole.
“Well, at least that’s the same.”
My childhood home is nestled in a sleepy subdivision of Newport, Kentucky. I can see the lights of the Taylor Southgate Bridge as we pull into the driveway, a toxic biohazard of a river separating the greener (or bluer) pastures of the Bluegrass State from Ohio. My dad likes to joke that living in Ohio had almost been a deal-breaker for him, who grew up in Lexington, and Mom, who grew up in Cincinnati. If she hadn’t agreed to live on the good side of the river, you might never have been born, he chokes out between laughs; every time, he looks at Mom for her reaction, and every time, she just rolls her eyes. Within a year of marriage, my dad got a job as the principal at Washburn Elementary School across the river in Cincinnati and was commuting every day, complaining of the drive. She says his pride could have saved them enough gas money over the years to become millionaires.
My mom is slumped on the couch when we walk in the door, arms flung over pillows, gray hair scattered around her face. Everything else fades, and my eyes go right to her chest with a panicked flick. I freeze in the doorway, and my dad moves as if nothing is wrong, asking me in a soft voice to close the door behind me before I let all the heat out. I have to watch several times as her chest rises slowly, depressing with the air whistling out of her open mouth, before I can shut the door. Breathing means functioning lungs. Breathing means life.
After the panic abates, the rest of my senses catch up. Her breathing hitches in her sleep. I cringe at the way it lodges in her throat and struggles its way out through cracked lips. I wonder when the last time Dr. Hawes ran a pulmonary function test on her, if she is hypoxic. I grind my teeth, reminding myself that she’s my mom.
“She had a long day,” Dad whispers to me. Last month, she was diagnosed with Chronic Fatigue Syndrome, or myalgic encephalomyelitis (myo, muscle; algia, pain; encephalo, brain; myel, spinal cord and medula oblongata; and itis, inflammation). It’s all arbitrary. Her brain fog, constant need for naps, the debilitating volatility of her symptoms, it could just as easily be explained by her endometriosis operation the month before and an adverse reaction to the anesthesia. The causes of CFS are unknown, the symptoms vary from patient to patient, and there is no cure. But a diagnosis with an official name, something my mom so rarely gets these days, sounds better. It makes the doctors sound less like they’re blindly fumbling in the dark (they’re almost always fumbling in the dark).
“I’ll just talk to her later,” I whisper back, flinching as I watch my dad grab a frayed quilt from the back of a chair and drape it over my mom’s body, over the swollen joints of her fingers nestled by her cheeks (rheumatoid arthritis, cause unknown). I give her a wide berth as I scoot around the edges of the living room, and I try not to think of that look families get when they’re told their loved one is contagious—that they will have to interact with this husband or daughter or son through a barrier of masks and gloves, always a step removed.
My dad sets my suitcase down on the bed in my old room. It hasn’t changed much over the years, from blue to purple walls, from polka-dot to plain white comforter. I hadn’t bothered taking much with me when I moved to Lexington for PA school at the University of Kentucky; I just shoved everything from my undergrad closet apartment to my grad-school closet apartment. I packed even less for the “big drive” to Minnesota and bought furniture from a thrift shop.
“I was thinking we could order Mexican for dinner—your mom’s favorite, since it is her birthday weekend.” Dad smiles, and for a split second, I have just thrown my backpack on my bed after driving home from Newport Central Catholic High School and I’m worried about college applications or some stupid shit and dying is an abstract.
The symptoms manifested my senior year of undergrad. I was home for the weekend to escape campus, and my mom and I went out to Target together.
One moment my mom was acting fine as she pulled the SUV up to a parking space, and the next, she was gagging and reaching for a watered down McDonald’s Coke in the cupholder. Bile and mucus splashing into a stale soft drink is not as pleasant as it sounds, so I threw open the car door and leaned out into the heavy spring air. She acted as if nothing had happened, replacing the top of the translucent lid. After reapplying her lipstick, she marched into the air-conditioned corporate maze, wheeling a shopping cart in front of her. I broached the subject while she was looking at a book about pet psychics.
What’s wrong? I asked her. She replied that it was just the antibiotics. Antibiotics for what? Malaria. Where the fuck did you get malaria in Cincinnati fucking Ohio? A mosquito.
Are you going to be okay?
The doctors thought my mom had picked up malaria from some errant blood-sucker in the humid wasteland of Ohio. Later, we learned that the malaria had actually been dormant for years. My mom suspected it was a souvenir from her and Dad’s honeymoon in Cancun (malaria mosquitoes are apparently too exotic to want to live in Ohio in her opinion). But it doesn’t change anything, the knowing it was dormant and was then awake. It’s still not enough knowing—it never will be.
Malaria is curable. The doxycycline killed the reawakened parasites in her blood and brain. The summer after graduation, when her treatment was complete, we went to the Outer Banks, North Carolina. She body surfed with me and Dad in the rough waves, tumbling under the salty spray and reemerging covered in sand. I’d always loved how the sun brought out my freckles so that I looked more like my mom. We took leisurely hikes in the wild horse sanctuary behind the rented house, and she would call at night for me and Dad to watch from the porch as the wild mustangs reared back and stomped their hooves to the crash of thunder, illuminated in jagged stripes of lightning.
On our last day, Mom could barely get out of bed. I spent the day on the beach alone, watching trucks and SUVs get stuck in the temperamental sand, while Dad stayed inside, reading from his Kindle as Mom napped beside him. The tiredness never went away. When we got back, they diagnosed her with some kind of malarial co-infection. Then hypothyroidism. Then Celiac’s disease. Then Lyme Disease (but what were the odds that she’d get the short end of the stick on mosquitos and ticks?). She went on the FODMAP diet, the paleo diet, the Candida diet. They decided the problem was not in her gut, wasn’t bacterial or parasitic. The diagnoses piled up, specialist appointments innumerable. I forget at what point they stopped trying to guess the cause and started just treating the symptoms (the treatment plan of the terminal).
I feel out of place. Last time I sat at this table, in my normal spot across from a painting of Keeneland race horses while my parents sat at either head, some part of me was still a daughter. I had just passed the PANCE, and we were celebrating the news that I officially had a position at Abbott Northwestern secured in Minneapolis at the beginning of the next month. No one knew I wasn’t just moving—I was running away, intoxicated by the amnesia of the out-of-sight. At dinner that night, I’d watched my mom’s eyelids flutter closed, the wrinkles around her eyes and mouth softening, and listened with a bittersweet warmth in my chest as she said the familiar words: Bless us, our Lord, and these, thy gifts, which we are about to receive from thy bounty. Through Christ, our Lord. Amen.
Now, I keep my hands in my lap even when my mom tries to reach out. She lays a hand, palm up, on the table, and I wonder if any part of that daughter still exists, if I left that role behind forever when I decided to make my leaving more permanent than an hour away in Lexington.
“Bless us and thy gifts from your bounty. . .” Mom stumbles over the words, trailing off, and I wince.
“Amen,” Dad says as if nothing is amiss. I start slicing my quesadilla into a bite-sized grid.
“I forgot to double check the boxes when I picked it up. Is everything right?” He mumbles between bites of arroz con mariscos, a shrimp tail dangling from the corner of his mouth.
I nod, hoping the awkwardness of the prayer will be the worst part of the dinner, but my mom coughs while trying to answer his question. In seconds, she is stumbling to the bathroom down the hall. I screw my eyes shut. Throat scraping, hacking coughs. Gagging. The plop of liquid hitting the ceramic sink bowl. Rinse and spit.
I narrow my eyes at Dad, who is wolfing down a bite of orange rice. I call almost every week, but I mostly talk to my dad, and I never ask for details about Mom (you can’t treat something you can’t see). But now that I’m here, I can’t shut out buzzing questions forming their old patterns in my head. “Is she keeping down meals?”
“Dr. Hawes has her eating six times a day. . .It’s hard for her to remember. She doesn’t really get hungry anymore. . .”
I add this to my mom’s chart in my mind, reassembling it piece by piece. “Is she still on Zofran?”
“When was her last appointment with Dr. Hawes? Did you tell her the nausea has gotten worse?”
“It’s been this way for a while, sweetheart. Dr. Hawes knows.”
I flinch at the unspoken, everyone knows. Except me.
My mom returns smelling faintly of stomach acid, and I continue to chew my quesadilla methodically: 20 times between the molars to prevent choking, to allow previous bites to digest, just like the adults taught us. My mom sits, and I look up far enough to catch sight of her sliding her plate away, a half-bite missing from a pool of refried beans and the rest untouched. Dad sighs. “Are you really done?”
Her hands slam the table where her plate had been, and I flinch, imagining carpals and metacarpals grating against one another. “You think I shouldn’t be able to decide when I’m done?”
Dad’s voice gets tight, coiled like a fist ready to punch. “It just seems like you aren’t even trying lately.”
Mom’s voice is hoarse with tears. “Everything tastes like shit, okay? Do you even want to understand what that’s like?”
That’s a stupid question. Of course my dad doesn’t want to know what that’s like—it would mean he were dying, too. And if he were dying, there would be no one to take care of my mom.
My eyes flit to my mom’s. If I focus there, I can see the green flecks swirling in a turquoise sea. I can see her. The puffy half crescent shadows underneath the sweep of her dark eyelashes. The spider-web fractures stretching to her temples. The eternal black of her pupils.
At least we would be dying together, they seem to say.
Why do either of us have to die? my dad seems to whisper back.
When I started PA school, I thought I had a head start. Look, I thought, I already care about someone who is sick. I already understand compassion and bedside manner and the capacity of human beings to suffer. I am becoming a PA to save someone, I thought. I am more noble than the rest of you.
My first patient in rotations was a 12-year-old kid with shards of his radius protruding through the red, swollen skin of his forearm. I choked out my questions, averting my eyes at the tears crawling down his cheeks, white-knuckling the chart. I spoke over him, to his mother. Other injuries? No. Where did it occur? The neighbor’s—she didn’t see it. She nested one hand in his hair, the other stroking his shoulder.
But I couldn’t touch him. I couldn’t place my hands on the fracture site. Couldn’t check for damage to soft tissues. Couldn’t test his nerves. Couldn’t monitor his circulation. All I could see was my mom throwing up into a day-old McDonald’s cup, alone in the car parked outside Target. Suddenly, I was 21 again and scared. So fucking scared.
I paused. His mother noticed, asked me what was wrong. With trembling hands, I abandoned his chart and called over a nurse. This boy needed someone else. Not me.
I still can’t touch my mom.
“Oh, come on!” Dad and I groan simultaneously, pausing on the “something that is bright” category in our game of Scattergories. I shake my head, cheeks bunched, sore from the strain of laughter. “Honey is not bright, Mom.”
I am wrapped in the rose-embroidered quilt my mom always keeps at the foot of their bed, leaning against the saggy couch in the living room. If I close my eyes, I am listening to my parents’ laughter, but I am also home on school day, sick with bronchitis or a stomach bug. The quilt is warm and heavy, and I know any minute my mom will bring me a steaming mug of green tea with honey. She’ll stroke my forehead and lay in her bed with me watching HGTV all day.
“It is so bright! Go in the cabinet and find it, and I’ll show you.” My mom waves her half-filled sheet towards the kitchen, indignant, and I focus on the whipping sound the paper makes in the air.
“We don’t need to see it to know it isn’t bright. It’s freaking brown.” My voice is tinny, and I look to Dad for support. His face is plastered with a grin, and I know he has that romantic comedy vision—the one that makes everything blurry except for my mom’s face.
“The reflection on it is bright,” she argues. “That shit can blind you.” She says it as if she has a Ph.D. in brightology, as if she has dedicated her life to studying individuals who have been blinded by staring at honey.
“You know the rules,” I declare before she can launch into a lecture on the intense corneal damage sustained by honey brightness.
“There’s two of you, always against me. That’s no democracy,” Mom grumbles.
“Who among us thinks mom’s answer is certified bull crap?” I ask, and Dad and I both shoot our hands in the air. “The decision is unanimous: honey is not bright, and you get zero points.”
I snicker as she draws a line through her answer, shaking her head in mock anger, her mouth betraying a smile at the corners. For a moment, like a double-exposed photograph, her hair is blonde, not thin and gray, silky waves falling to her shoulders. For a moment, the two versions of my mom are one and the same.
But then she coughs, hand pulling away bloody, and my dad is grabbing a Kleenex, and my mom is going to the bathroom to vomit. I want to clap my hands over my ears, block out the gentle comforts of my dad and the choked responses of my mom. The phlegm and crimson droplets hitting the ceramic bowl of the sink. The pat, pat, pat of my dad’s hand on her back. The swish of water in my mom’s mouth, cleaning the blood and bile from her teeth.
On my mom’s birthday last year, my parents flew to Minneapolis to see me. The flight was direct, only two hours, but by the time they got from the airport to the hotel, my mom was bed-bound for the rest of the day. I took my dad to Minnehaha Park, and we watched the freezing blue water cascade over plumes of ice and snow.
We sat on the little stone fence beside the falls, and my dad told meandering stories about how he missed the farm-country Lexington of his childhood, or how a blizzard had once snowed him in to the Eastern Kentucky school where he’d gotten his first job and he’d slept on the gym bleachers, or how his first girlfriend had taught him to kayak and she’d broken up with him because he’d burst into tears after flipping his boat right as a water moccasin slithered past. But all of his stories took place in a history that ended in 1986, the year he and Mom met, as if speaking her into narrative shifted the balance of her life too far into the past tense. But her absence tacked itself to the ends of trailing sentences, and I knew that’s how the future would feel, always.
I wake to the sound of knocking. I struggle to untangle myself from purple sheets coiled around me like chains, woozy from a handful of hours of fitful sleep. “What?” I call towards my door.
My dad takes that as an invitation to come in, but pauses halfway through opening the door, and I think we are both surprised at the strange feeling that he has breeched some adult-daughter code of conduct by entering without asking.
“The school just called,” he says. “Apparently, some kids broke in as a prank, and now I have to drive out there and talk to the police. . .” He trails off, looking to me for a response, as if he doesn’t want to have to finish. I blush, embarrassed that he thinks that I, a medical professional, can’t take care of my own mom for a few hours.
“Go, Dad. I’ll be just fine.” I give him my best comforting-a-cancer-kid smile, and he seems to buy it.
“She still needs to take her morning pills—”
“Dad, I know.”
“They’re in the box on the counter—”
“Labeled Saturday a.m.”
His eyes scrunch upwards at the corners, and he pats my head like he used to when I still slept in this bed and couldn’t recite the side effects of Zofran off the top of my head (headache, fatigue, constipation, diarrhea, and skin redness).
“I’ll just be a couple of hours.” Dad frowns, as if he’s about to reconsider leaving once again, but I jump up and push him towards the door before he has a chance. It’s easy to avoid my responsibility, my familial duty, to help my dad when I’m in a different state eleven hours away, but face to face with him, with the guilt and shame and regret, it’s impossible to say no.
Once the door shuts and I hear his car start, I get the urge to run outside and call him back in—offer to go to the school in his place. Ask him to call the police and delay their questions until Monday. Anything to keep me from being almost alone in this house.
After my undergraduate graduation, my parents took me to the levee, and fancy clothes be damned, we flashed our annual memberships, shuffling into the musty air of the Newport Aquarium.
We stayed in the jellyfish room a long time that day. They floated unencumbered through tanks backlit by shifting purples and blues. I leaned my head against my mom’s bony shoulder, tracing the trail of translucent bells. I inhaled the scent of her—the sharp citrus of her hair, her flowery perfume. I flicked my eyes up, my perspective tilting the angular curve of her nose, her aquamarine eyes and crow’s feet from smiling too hard and too often, the shadowed lines of her cheekbones stretched taut.
“The plaque says the moon jelly can’t move much,” my dad murmured.
The jellies sail aimlessly through the water, tumbling, pulled away from one another at the last moment.
“Even when they swim, they mostly drift with the current.”
I inhale deeply, imagining the alveoli puckering and the meaty tissue swelling like an inflated tire, trying not to think of how my mom’s breaths would sound under a stethoscope. With a glass of water in one hand, pills tucked in the other, I knock on her door.
She doesn’t answer, so I push the door open. There are pill bottles everywhere—stacked on the bedside table, in boxes on the floor, in Walgreen’s bags, empty in the overflowing trashcan. Some are orange prescription bottles of NSAIDs or Zofran with printed labels wrapped around them like slash marks, and others are supplements with bullshit brand names like Nature Made (I’d like to see some snow-white circles of Magnesium in their natural habitat). I try to picture my parents’ room before, but all I can remember is the comforter half-obscuring my view of the television screen while I fever-napped on days I missed school.
“Mom?” I say to the shadows that slip over her forehead as clouds pass through the window above the bed.
She coughs, so I know she’s heard me. Delicately, I move the glass of water towards her hand and from how badly it’s shaking, I know it’s going to be a bad day. The kind of day where, when she was stronger, she had gotten so frustrated about her body turning on her that she’d woken up me and Dad by smashing half the plates in the cabinet on the kitchen floor. Afterwards, Dad had suggested counseling, and she’d promptly told him to go himself if he was so traumatized.
There’s a hollow ache in my chest, and as I lift the glass of water to her lips for her, laying her assorted vitamins and pain meds and miscellaneous symptom-treating drugs into her outstretched palm, I catch a glimpse of her face. Her gaze is unfocused, searching without intent, and her expression is that cusp of numbness that a patient gets the moment anesthesia kicks in—when their body is going to sleep, but their mind is still fighting.
She gulps down the pills with a practiced swallow, and I turn to leave. Just as I’m out of grasp, I see movement from the corner of my eye. My mom, reaching out. I inhale. Turn.
“P—please. . .stay.” She struggles to say the simple words, and my bones threaten to crumble into powder. Her gaze, drained to the grey-blue of a storm, is locked on me like I am the answer she had been searching for, and I climb onto my dad’s side of the bed, leaning awkwardly away from her.
She sighs. “I—” A long pause. “It’s hard for me. . .to think.”
I clench my jaw, biting back a slew of medical explanations for the intersection of brain fog (clouding of consciousness) and chronic illness. Instead, I just nod a stiff bedside-manner nod.
“It’s like. . .I—I’m not. . .myself.”
I can’t help but look over at the pain in her voice. Tears flow down her cheeks in fat rivulets, and I want to look away, but by reflex, I analyze with my gaze, try to gauge the source of her pain: nerves, tissues, bones—treatable—or something below the cellular level, something primal and untouchable.
“I know,” she hiccups, “I know I’m in here,” she points to her head, “somewhere.”
Her gray hair is frizzy, hanging in oily, tangled locks beside her cheeks. Laugh lines and crow’s feet and blue capillaries and a right front tooth that is slightly longer than the left. A voice that conjures memories of bellowing renditions of happy birthday and yelling “you are a b-i-t-c-h” out the car window when someone cut her off and whispering with Dad in the open doorway when they were checking that I was safe and asleep.
“I just. . .I just can’t reach. . .” She trails off, tears glistening on her freckled skin, in the dips and bruises and wrinkles. I’m thinking of her history and my history, and how my life was entirely dependent on hers, and how debilitating it must be to wonder whether your end means someone else’s too, when her panicked eyes settle on me. “What,” she breathes, eyelids fluttering closed, “are you thinking about?”
Do I still have time to be a good daughter? I think. Do I even have time to go back to being your daughter? Instead, I say, “Do you know what my first memory is?”
I settle back against the headboard. “There was a tornado warning, and it sounded like the roof was about to come down on us, so you convinced me that we were gonna have a movie night in the basement. You spent the whole night yelling—and, I mean, full theatrics—trying to get me to eat a damn salmon patty. And I just remember being so disgusted by the mere idea of eating that room temperature lump of mush, and you screaming at me that I couldn’t watch Flubber until I finished the whole thing. But then, looking back, I realized that I don’t remember the tornado warning at all. I don’t even remember being scared. Dad’s the one who told me that a tornado went through Covington that night, miles away from us. But all I remember is that goddamn disgusting salmon patty.”
She laughs, and I laugh, and when she interlaces her soft fingers through mine, I flinch but don’t pull away. Her skin is more wrinkled than I remember, a topography of unfamiliar grooves.
We’re silent for a moment, then she sighs. “Do you remember Target, that day. . .”
I fill the rest of her sentence, the memory sharp in my mind. “When you first told me you were sick.”
She smiles, and I think she’s going to ask me why I leaned out of the car, why I left her for Lexington months later—that it always goes back to me leaving.
“You asked me a thousand questions,” she laughs breathily, “with all this medical lingo, so I didn’t even know what the hell you were talking about. And you made me bring you to all my follow-up appointments that summer and took g-d notes the whole time.” She clears her throat, swallows laboriously. “It’s how I knew you’d be a good PA.”
I’d forgotten about those appointments, the hours spent in sterile hospital rooms and outpatient labs. I’d held my mom’s hand and watched them draw blood, demanded detailed annotations for her lab results, lay in her bed beside her for hours watching millionaires buy million-dollar houses when the doxycycline tanked her energy levels.
My throat tightens, eyes burning. “I feel like I’ve wasted so much time—”
She shakes her head, pressing her lips to the back of my hand. Skin to skin, I feel her pulse in my fingertips. I don’t apologize. Instead, story by story, the walls between us disintegrate, blood-brain barrier compromised.