Читать книгу All the Difference - Patricia Horvath - Страница 11

Dry Bones

The doctor was “astounded.”

Patient suffers from marked osteoporosis, the report read. Fracture risk is high. Treatment, if not already being done, should be started.

He told me the results did not make sense. “You have the bones of a seventy-year-old. Are you sure you don’t smoke?” “Never.” “And . . . you’re definitely still menstruating?” “As we speak,” I replied. What I wanted to say was “See? You should have believed me!” because for nearly two years I’d been insisting to skeptical doctors that I was shrinking.

Two years earlier I’d been living in Massachusetts, finishing up my MFA degree while teaching sections of freshman composition at two different schools. On a typical day I got up around seven, made a pot of coffee, and drank it over the course of several hours while I wrote, then headed to my grad courses in the late afternoon. Tuesdays and Thursdays I taught morning classes at a state college and afternoon classes at my university. Either way, sometime around noon I’d rush through a meal of yogurt and fruit. Dinner was just as perfunctory—defrosted soup, maybe a sandwich. Weekends I wrote and graded and looked for jobs. Some nights I met up with other grad students at readings or bars where we drank beer and listened to music and talked about life after graduate school, which in my case would entail a move to Harlem and an adjunct teaching job. The job would eventually grow into a full-time position, but I could not know that then. Meanwhile, I drank too much coffee, ate too little, exercised infrequently, and all the time I was slowly shrinking. I could not know that either.

Because I was graduating, and losing my health insurance, I decided it would be a good idea to get a check up. Aside from intermittent bouts of insomnia, which I’d had since adolescence, I felt fine. Nevertheless, one morning in late May I took off my shoes and stood on the doctor’s scale. I’ve always derived a certain goofy pleasure from these check-in rituals. The nurse straining on tiptoe to record my height. Or nestling the larger of the scale’s two weights into the one hundred pound slot then sliding the smaller weight too far to the right and having to guide it back—slowly, slowly—well to the left of where she’d started. The inane, jocular comments: My you’re a tall drink of water! And: I bet you can eat whatever you want.

This time, though, the nurse barely had to stretch. She rested the level against my head and wrote down a number—sixty-seven inches. But sixty-seven inches was wrong.

I’m five-eight, I said, startled. The scale’s not right.

It’s a scale.

She picked up the blood pressure cuff, waiting for me to roll back my sleeve. Other people were waiting too—a room full of patients she had to weigh and measure. This nurse was a busy woman who did not have time to indulge her patients’ whims. Still, she relented. I stood up as straight as I could. I pulled back my shoulders and lifted my chin. The vertebrae in my spine cracked as I tried, uselessly, to will them to straighten. I stretched and stretched to my full height . . . five foot seven.

But last time—I began.

You can discuss it with the doctor. Now let’s look at that blood pressure.

In the doctor’s office I changed into a crinkly paper gown. The day was unseasonably cool; I could feel goose bumps rising on my arms. I wanted my coat. I wanted to go home, get my coat, start the day over. Come to think of it, if I’d really shrunk an inch, why did my coat still fit? And my other clothes, few of them new. Shouldn’t my pants be dragging the ground, my sleeves dangling?

I thought of my father’s mother, hunchbacked and tiny by the end of her life. Didn’t I take after her—birdlike in a family of big-boned people? She’d been diagnosed with osteoporosis, the “widow’s stoop,” as it had then been called. I knew the risk factors, knew they were against me: a small-boned Caucasian woman, dwelling in a northern climate and living the sedentary life of a graduate English student who’d just spent the past year teaching seven courses at two different schools while working on a book. A woman who, as a child, had loathed milk and spent her summers reading indoors. Someone whose biggest treat had been a trip to the library—not the children’s library, but the adult one where the floor was made of glass bricks lit from below and the book titles were not, I understood, to be taken literally but instead held mysterious, hidden meanings. My grandmother and I spent hours in the stacks. She craned to reach the higher shelves. We were alike in more ways than one. Still, she was my grandmother, old before I was born. Women my age weren’t supposed to shrink.

The doctor came bustling in—smiling, pleasant, visibly harried. She apologized for keeping me waiting, and she began to ask about my general health.

I’m shrinking, I interrupted. I think I have osteoporosis.

She looked at me, clearly puzzled. I’d been seeing this doctor for years. She was thorough, calm, a good listener. We’d commiserated about issues of women’s health: the needless difficulty, say, in attaining the “Plan B” morning-after birth-control pill or the nearly instant FDA approval for Viagra while RU-486, the French “abortion pill,” had been banned by the FDA for over a decade. So I was genuinely taken aback when my doctor told me no, this could not be, I was far too young to have osteoporosis. A baseline bone density exam would be conducted at the onset of menopause, perhaps another ten years. How short, I wondered, would I be by then?

I could feel a small rip opening at the back of my gown as I shifted in my seat. My thighs stuck to the hard plastic of the chair seat. I wanted to get on with the exam, but I knew I was not leaving until she took me seriously.

I’ve shrunk an inch, I said.

The doctor looked through my file. She had no record of my height. My last measurement must have been with my previous doctor, at least three years earlier. Perhaps, she suggested, that scale had been inaccurate? Perhaps I was mistaken?

I’m a shy person, soft-spoken. I dislike confrontation. On the subway, if someone vacates a seat, I’ll look around to see if anyone else needs it before sitting down. If a student comes to me upset about a grade, I’ll listen to her arguments. Sometimes I even change the grade. But this was different. This woman, my doctor, was standing between me and my health. Because the insurance industry or medical profession or whoever it was who makes these decisions had determined that women my age could not have osteoporosis, women my age were not tested for the disease. How then could I support my claim?

I told the doctor that I needed her to authorize a bone density exam. She refused, saying that premenopausal women are not at risk for osteoporosis. But my mistrust of my body—too profound for her words to sway—convinced me I was right.

Look, she said, it’s highly unlikely you have osteoporosis.

Highly unlikely or impossible?

The doctor opened her desk drawer, took out her prescription pad. Patients were backed up, waiting to see her; not yet noon, it would only get worse. We hadn’t begun my exam. She wrote something down and, unsmiling, handed me what I needed.

When the results came back, she called. The doctor said she was sorry for having doubted me, it was good I’d been so insistent. Still, I had to understand how unusual this was. I felt vindicated, but also angry. Not only at the doctor, but at myself. Why hadn’t I noticed that in three years no one had recorded my height? Wasn’t I the one ultimately responsible for my health? If I’d paid closer attention . . . then I stopped. How else could I have known? I had to shrink to realize that I was shrinking. I hung up the phone and began to cry. You’re my doctor, I wanted to shout. What if I had listened to you?

Femur, tibia, fibula—I pictured the long bones in my body crumbling to powder. The doctor had mentioned Fosomax. I’d seen the commercials: silver-haired women rode horses and did leg lifts at the ballet bar while an announcer intoned See how beautiful sixty can be. As far as my doctor knew, no studies had been conducted about the long-term effects of Fosamax on forty-year-old women. She’d called an endocrinologist at Massachusetts General Hospital who’d told her that Fosamax can remain in the bloodstream for up to seven years. Supposing I became pregnant?

The doctor recommended exercise, calcium, Vitamin D, a follow-up visit in a year. It was nearly two years, however, before I had health insurance again. This time I knew exactly what to do. I made certain I was measured. I’d shrunk another quarter inch. When my new doctor balked (Osteoporosis? Are you sure?) I had proof. Now, with a fresh batch of results showing further bone loss, he was “astounded.”

He said it was essential I start taking Fosomax. He also set up an appointment with an endocrinologist at St. Luke’s Roosevelt Hospital near Columbia University. Late winter, early spring I walked from my apartment in Central Harlem past the decaying buildings along Frederick Douglass Boulevard, through Morningside Park, up the hill to Amsterdam Avenue, where the neighborhood abruptly turned cleaner, shuttered buildings giving way to bookstores and cafés, welcoming beneath bright awnings. Snow melted to mud, crocuses poked through the earth, then daffodils, tulips, until the park was a riot of new growth.

The endocrinologist—British, exceedingly polite—ordered tests. Lots of tests. I had blood drawn twice, another bone density scan. For twenty-four hours I peed into a jug that I lugged back to the lab in a plastic Fairway bag. The next day I got a call—they’d neglected to give me a vial of preservatives to mix into the jug; I’d have to redo the test. Up and down the hill again with my jug of urine. When the tests finally came back, they revealed nothing—except that I had osteoporosis. The endocrinologist confessed to being “perplexed.” But I was not. My bones have always been treacherous, and once again they had betrayed me.