Symptoms of Heart Disease

          My mother and I are eating breakfast on the living room floor. It is the summer after my freshman year of college. The sun is just beginning to break through the mist in our backyard, which has grown into a veritable jungle under my mother’s care. I can see our geriatric rabbit, Fatass, peeking out from behind the fig tree. She is stuffing herself with fallen fruit the size of my fist. Since she only has a couple years left, we let her do what she wants. Live life blissfully – that is our family motto. We even have it carved onto a massive brass plaque in the hallway.

I turn back to the obituary section of the Saturday paper. I am counting up the winners and losers. Every year under thirty earns a point for emotional pull. Every year after eighty also earns a point for exceeding expectations. Brain and pediatric cancers receive five points each because they are objectively the worst. Vets receive three points for the trauma of war. For each limb lost, they receive an additional two points. WWII vets receive five points instead of three. This is because WWII must have been a beautifully tragic time to be alive, for the same reason that Independence Day was a blockbuster.

Practically speaking, obituaries should no longer exist. There are faster ways to contact friends and family of the deceased. And if you are over eighty, chances are you have few of those anyway. No, we write obituaries so that others can watch us grieve. Their function is purely masturbatory, not that I object. They make my Saturday mornings. Obituaries only say nice things, so you get to fill in the gaps. Today I am reading about Tom, who was a loving father of three. From his photograph I can tell that he was also a loving consumer of anabolic steroids.


          I dip a piece of rusk into my milk, thinking about how Tom will never drink milk again, when the phone rings. My mother pushes herself off the floor to take the call. I watch her walk into the kitchen, her thick, wiry hair bouncing with each step. She used to be very pretty, but after two kids and fifty years, things happen. Her best friend is a lonely housewife who sometimes calls to discuss the marvelous growth of her tomato plants. My mother deals with her situation by spewing Buddhist epithets, like the one in our hallway. They put things into perspective. One side effect is that she rarely cries. In fact, to the best of my knowledge, she has cried only three times in the last twenty years. Here they are:

The first time I was five, and it had made no sense to me. My mother was crying over the kitchen sink. She yelled that my father did not understand, and he said that he would do better. In the moment she could not string full sentences together, and later she denied it every happened. So I hated my father for fucking it all up, whatever it was.

The second time I was in fifth grade, and a phone call had interrupted family game night. The number was registered to my mother’s brother, who was working tech in Bangalore. Then, out of the blue, my mother started screaming from her chair, and my sister prostrated herself on the floor without really knowing why. She has a lot of feelings, so we have to watch ourselves around her. My father stood over them both, afraid to touch. Finally my mother revealed that my grandmother had been sick for a while, but that my mother had not listened, and now my grandmother was dead. I locked myself in the bathroom and pretended to pee for a few hours. But a few weeks later she changed the story: my grandmother had not been sick after all. She had tripped over the side of the well, reaching for the bucket, and had died either on impact or of a heart attack. My grandfather had to fish the body out with a net. This version best fit the facts, because at the funeral no one was allowed near the well. Later it was covered with metal latticework. The gaps between the bars were so small that even my foot would not fit through.

The third time was my fault, so it is hard to say out loud. Just before my high school graduation, my uncle from Tennessee had sent me a check for five grand. When I came home from school that day, I saw that my mother had already opened the envelope. Boundaries were never her strong suit. She still thinks it is okay to walk into the bathroom when I am showering, because it is nothing she has not seen before. But it is nothing she has not seen before only because she walks into the bathroom when I am showering.

So, understandably, this envelope was the last straw. Suddenly I felt that she was suffocating me, that she thought me an extension of herself when actually I was my own damn person. And that was precisely what I told her. Then her face spasmed, as if it were simultaneously splitting and reattaching at its seams. There was something altogether foreign about it, so I repeated myself. My mouth has a destructive streak, on account of her genes.

Then she had locked herself in the bathroom, and my father would not look at me for a week. Later he rented that Barbra Streisand movie, The Guilt Trip, and left it in the DVD player hoping we would watch. He is a smooth operator, my father.

Now my mother is crying again, so I forget all about the obituaries. Because our house is chic, we have no walls between our kitchen and living room. Thus I can see her face over the bar counter. Her friend Vasudha Bhatt, not her best friend, is on the phone. She is saying something about a tumor, and things not looking good. There were no signs, until there were. My mother takes herself off speakerphone when Vasudha starts crying, so I am forced to witness the bulk of the drama with only half the dialogue.

And let me tell you, my mother is not an open book. In fact, and I mean this endearingly, she is a frigid bitch. When I was younger, she would pour cinnamon oil on my scraped knees, because cinnamon oil promotes growth of fibroblasts, ‘a cell type important to healing.’ All I knew was that it hurt like a motherfucker, so I stopped scraping my knees. So in a way it did work. The last time I injured myself was in the eighth grade, when I dislocated my elbow jumping between the community pool and the hot tub. My mother fashioned a sling out of her dupatta and rubbed my back while we waited for my father to pull up with the minivan. I had asked for an ambulance, because the pain was unfathomable, but she had felt that a Dodge Grand Caravan would make less of a scene.

At the hospital we learnt that I would need minor surgery, but surgery was surgery and I did not want to die. So I told my father to push the orthopedic surgeon out the window if the operation went south. He was more traumatized by my pain than I was, so he agreed wholeheartedly. Then my mother told us to keep quiet, because what would the hospital staff think?

But she was sympathetic, in her own way. For four months, she did all my math homework for me because I could not hold the pencil myself. Thank God I had her brains, she said, or else it would be tough to play catch up.

That is my mother, in a nutshell.

So I know something big has happened. She is catching snot on her sleeves. It looks like spider silk. In a stunning display of tenderness, I hug her. Then I ask what is the matter, does Vasudha have cancer?

We have known the Bhatts since before I was born. My parents went to college with Vasudha and Raj. We immigrated to the same region of Northern California within months of each other. I am two years older than Vasudha’s daughter, Shashima. My sister, now thirteen, is two years older than her son, Shreyas. Along with the Murthys, we spend every major holiday together. Christmas we always celebrate at the Bhatts, because Shreyas shares a birthday with Jesus. To be clear, we do not believe in Jesus. We believe in ourselves. But with most of our extended families overseas, this is the best we can do.

So it would be sad if Vasudha has cancer. The family dynamic will shift drastically. The Bhatts will probably stop hosting Christmas. Not that I can blame them. I would not want to host Christmas either, if my mother died.

But then my mother ups the ante. She says that actually, Shreyas is the one with the cancer. More specifically, he has a malignant tumor in the brainstem, and surgery is not an option. It is like we are in a soap opera, but without the theatrics. Her nose is crusty so I hand her my scarf.

Not much can top pediatric brain cancer. Even Jebediah, the ninety-six year old paraplegic WWII vet from last Saturday, has nothing on Shreyas. If surgery is not an option, prognosis is shit. If it is brain cancer, prognosis is shit to begin with. My mother likes to say that after forty, all bets are off. But eleven is nowhere near forty.

My sister and I have not been eleven for a while.

And with that, there I am, on the precipice of death. It feels like a dry heat against my skin, drilling ferociously into the pit of my stomach. On one hand, now it is clear I can die too. On the other, I get to watch someone else die, someone I have known since the day he was born. There is a lovely fullness to it, like library shelves with no gaps between the books. I focus on this. Mortality is not an easy pill to swallow, so sometimes we have to mix it into our food like we do with dogs.

I wonder how his parents are taking it. Presumably not well, but how exactly? Are they starving themselves?

Yes, my mother says. Raj especially. He has already lost two pounds.

And Raj has a slow metabolism, if you know what I mean, so two pounds is a lot. I wonder if my father would do the same were it me at Death’s door. Like my sister, he has a lot of feelings. They overwhelm him, which is why he so assiduously avoids them. My father does not kiss my mother and, as far as I can tell, they have not had sex in at least a decade. He might be a latent homosexual. For the longest time, my sister even thought she was adopted. To be fair, that was because I told her so. That was also why we now know to watch ourselves around her.

So yes, he would starve himself, but no, he would not cry. At least not in front of me.

I wonder if I would prefer it that way. Shreyas’ parents must have been crying in front of him, because the phone call came from the landline and he is at home. But if they are crying over his death while he is still pumping blood, then he might feel like hopping into his grave a few months early.

Shashima is probably the only one with her shit together. This makes sense because she wants to be a doctor one day. Perhaps now she will be an oncologist. She might feel obligated, especially if she mentions her brother’s cancer in her college essays. Not that we should exploit tragedy for personal gain, obviously.

Now my mother breaks the news to my father, who is at a conference in Arizona. I am hoping she does not give away too much, because I want to watch his reaction. In the meantime I Google “pediatric brainstem cancer, no surgery,” because Vasudha never called it by name.

It turns out that this is the worst type of cancer. It is also very rare. It is like winning Satan’s lottery. Everyone tries radiation, then drug trials. Some spend thousands on drug trials,because not all are government-approved. Stanislaw Burzynski runs one of these trials from a shed in Texas. He says Big Pharma hates him on account of his profit-eating miracle cure. But actually he just scams kids with cancer for a living. Because in the end, they all die.

And what a way to die. Over the course of one year, these kids lose mobility, speech, sight, and hearing. First they can only eat smoothies. Then they need a drip. Their bodies, pumped full of steroids, look like beachballs. Not cute beachballs either. More like morbidly obese rednecks in miniature. Then finally, one day, just like that, they stop breathing.

Most of them are between three and eleven when they bite it. So Shreyas was almost out the door when it swung shut. He got to see what was on the other side.

But that is not the worst part. The worst part is that he has to watch it all happen. The conscious part of his brain will work fine till the end.

So Shreyas will never kiss a girl or have a beer or fall in love. He will never kiss a guy either, if he swings that way. It is not so easy, deciding which way to swing. But what is easy is appreciating the tragedy of his situation. He will have to watch his future slip through his fingers like sand. Because he will die soon.

But does he know this?

It is only tragic if he knows.

PETA says that pigs scream at the gates of the slaughterhouse, and that is why we should care. PETA is right.

I keep this to myself.


** *


          My father reacts badly, which is no surprise. He takes an early flight home after my mother calls. He spends his free time browsing medical journals. So do I, but for different reasons.

Shreyas is being treated at Stanford. For a few minutes every day, five days a week, he receives sharp radiation to his brainstem. If he is not at the hospital, then he is either playing video games or sleeping. These are my mother’s words. When my parents take food to the Bhatts, I am not allowed along. Apparently my presence would make the Bhatts feel obligated to play host. So medical journals are all I have.

I think my mother is just worried that Shreyas will feel badly if other kids see him in his current state. But I barely know him. I am also an adult. If he feels badly about me there, then he should feel equally badly about my mother there. But I decide not to argue, because part of being human is not admitting that we like to stare.

The truth is, I am dying to see his cancer manifest in real life. I already know the facts. I can even identify the cancer in MRI scans. It is more like a net than a solid mass, with tentacles that weave themselves between healthy cells. This is why surgery is not worth the risks, according to his doctors. Most doctors in America say the same. It is beyond me how this can be the case when the alternative is certain death, but perhaps lawsuits are scarier. ‘Home of the brave,’ I have learnt this week, is not so much descriptive as it is aspirational.

I have also learnt this week that surgery is not as gruesome as you might think. I have been watching a lot of video tutorials. Molecular gastronomy is not as clean or precise. No wonder surgeons are so damn full of themselves. It probably does things to you, holding a beating heart in your hands. But then again, fucking it up probably does things to you too. This is why you need strong motor skills, an even temperament, and a utilitarian perspective on life. You also need a good bedside manner, or a surgeon buddy with a good bedside manner.

I would have made an excellent surgeon, but unfortunately it is too late for me to register under pre-med. Doors swing shut as you age. And one day, I predict after your first child, you are locked in a prison of your own making. So it is important to find your peace sooner rather than later. Easier said than done, but staring death in the face must speed up the process. If I could just see Shreyas, then I would know for sure. Until then, my imagination will have to suffice.

So I think hard about death. I think about how the medical establishment has failed me. I think about shitting into a diaper, and eating nothing but kale Gerber. I think about my mother, crying over my skeletal form. My skin is crumpling like paper, and her tears are caught in the folds.

I am sleeping in a hospital ward, my pasty legs visible under the sterile blue gown. Dozens of Get Well Soon balloons, pink and blue and yellow, bob in the air. My friends are not allowed to visit. They are leeches; they would suck my tragedy dry. Their hearts were ripped in two when they read my Facebook post, the one where I explained that I would be dead in a fortnight. Ben Windsor even proclaimed his undying love for me. Goddamn leeches, all of them.

So I am content to be with my mother, and only her. As I take my final breaths, my life flashes before me: sucking on mango pits in my grandfather’s barn, churning butter with a rope and a stick, the hot Indian countryside wrapping itself around my skin like Clingfilm. Fireworks every night, a rust-colored cow giving birth, cane syrup in an anthill, a cobra sleeping in my sister’s cradle. My grandmother’s jackfruit idli, coconut flesh so soft it resembles velvet. I begin crying. I am only nineteen, but what a beautiful life I have lived.

Boy is it tragic, dying young.

** *

          Today I leave work early to find chaga. Chaga is a miracle fungus that grows on birch trees. It is found primarily in Maine, Canada and Siberia. One town in Siberia eats so much chaga that no one there gets cancer, and they all live past a hundred. How it works is it keeps your telomeres from fraying, sort of like tape on a broken aglet. This way your cells do not sew the wrong ends together during mitosis. Studies also show that chaga does not interfere with the efficacy of chemo or radiation, so there is no harm in taking it alongside traditional treatments. Rainbow Groceries in San Francisco carries the best kind: high pressure, hot water extracted chaga. It takes me an hour to walk there.

I buy Shreyas a hundred dollars’ worth, two bottles of capsules and two of liquid extract, so that he can take it even when he can no longer swallow solids. I also buy a hundred’s worth for my sister and myself. No point in being stupid about these things.

The cancer manuals say I am overstepping, but science does not back these manuals. Science backs me. I include fifty pages of it, with all the relevant bits highlighted, in the gift bag I make for Shashima. Also included is Shreyas’ chaga and a note with my email and phone number, should she want to talk. Secretly I hope she does not want to talk. I hope she talks to someone else and I get the information secondhand.

My father is overjoyed when he sees the thought I have put into my gift. He thinks I do not care about people. I know this because when I was in eleventh grade, he said, “You do not care about people.” He had clearly been waiting to say it for a while and had grown impatient, because it had not made sense in context. My friend Joyce had just dropped off a box of homemade cupcakes for Christmas. I only knew her from summer camp, which had lasted lessthan two weeks, and we had barely talked since. So this was a pleasant surprise, which is what I told my father. Then he said, “Of course it is a surprise to you. You do not care about people. How could you understand?”

I took an extra long shower that day. For the rest of the week I tracked mud into the house and left dirty dishes on the living room floor. When he finally yelled at me, I got to say, “Well, what did you expect? I do not care about people. Did you think you were special?”

I guess he is happy I proved him wrong.

But he has always been wrong. The gift had included a card, which said, “Merry Christmas, Kavya! XOXO Joyce.” I still have it somewhere. I use it as a bookmark.


** *

          My parents are at the Bhatts with my gift bag. I was invited along but it had felt wrong to go. My stomach had turned at the thought of looking Vasudha in the eye. I would not have liked what was reflected back.

Instead I sit in my room, alone, flipping through old photo albums. It is already dark out, and the woods bordering our house have come alive for the night. Black-tailed deer tromp through the neighbor’s vineyard because chain-link fences are banned in our town. So are sidewalks and streetlamps. The council feels they would wreck the rural aesthetic. As a result we see a lot of animals. Last year a cougar even wandered into our backyard and almost ate Fatass. My father had to beat it back with a broomstick.

Maybe our town is too rural, but I prefer it this way. The silence is liberating, particularly when I have the house to myself. It gives me space to think.

And tonight, for some reason, I want to think about the past.

That is why I pulled my family albums from the back of the shoe closet. Now they are scattered across the bed, leaving squares of dust over my sheets. The older photos are of my parents in their twenties. The rest are of me at my grandparents’ farm in Sagara, where we would spend our summers. Every night, I remember, my grandmother would heat fresh milk in a saucepan, flavoring it with turmeric and saffron, while my grandfather and I put the cows to rest. My mother and her cousins would be crowded around woven mats, splitting peanuts or sifting rice. And from the rafters, our feral cat, Mother Cat, would watch us all with quiet disdain.

My grandfather died of lung cancer last month, but no one knew the cause until afterward. He never smoked or drank and walked ten miles a day, so lung cancer was never on anyone’s radar. When he complained that his chest hurt, my mother said that he was making a mountain out of a molehill. When his lungs filled with fluid, she said it was probably pneumonia. Old people often get pneumonia. I had called her insensitive, because his age gave cause for concern, but now I wonder if maybe she knew more than she was letting on. I never saw her cry either.

We let her attend the funeral alone. We had other commitments, and it is important to be practical about these things. We had done the same when my father’s parents died.

Now only her brother lives on the farm. He is not allowed to move because of the squatters. Leave a piece of land unattended for even a month in India, and you will find that when you come back it is no longer yours. It is also a challenge to find good tenants who will feed the dogs and clean the house and not run a brothel out of the barn.

Thinking about Sagara, about what I have lost, the photos have suddenly become exhausting to go through. But I cannot stop. It feels like I am whipping myself. When my parents return from the Bhatts, they can hear me crying.

We do not discuss this the next morning. It would have been too embarrassing for all of us. Instead my father tells me that Raj sends his thanks. Apparently he went through all my research, not just the highlighted portions.

I think my father is trying to cheer me up, but he does the opposite. I do not deserve the Bhatts’ gratitude. Accepting it makes me feel like a cheat.


** *

          My left eyelid is drooping. It has been for a week. It is drooping so low that my lashes are blocking my vision. I also have terrible headaches and have been sleeping very poorly. To counterbalance the sleep deficit, I have been drinking more coffee in the afternoons. This keeps me up for most of the night, so I wake up the next morning with an even larger deficit.

My condition leaves me so sick with worry that I cannot play catch-up over the weekends either. Shreyas’ cancer makes his eyes do funny things. While I am too old for his cancer, I am not too old for other brain cancers. The medical journals all say that ocular gliomas can cause your eyelids to droop.

My mother says I am being an idiot. She reminds me of that time last year when I found an ingrown hair on my breast and asked for a mammography. Then she reminds me of the time I found a mole on my ankle and purchased a liter of SPF100 sunblock. But this is different. This is my eye, and eyes do not droop like this. I almost wish I do have something, just to prove her wrong. I can already imagine it: her sitting in the hospital lobby, getting the news delivered. Her, begging my forgiveness. Me, giving it. Her, on her knees, sobbing, because what a big-hearted daughter she is losing. Then I imagine various permutations: me in the lobby getting the news delivered, me in the lobby getting Shreyas’ news delivered, me delivering the news to Shreyas’ mother in the lobby. The hospital lobby, I decide, must remain a constant, because it is the space in which the planes of life and death meet.

So finally, at my insistence, we do visit the hospital. Unfortunately my eye chooses that day to stop drooping, so I look like a buffoon trying to convince the doctor that yes, I am in fact dying. I have to pull symptoms out of my ass, ones that are not easily verifiable, to lend credibility to my story. Reduced mobility in the left arm, cramps in the left side of my chest, sudden dizzy spells, things like that.

But apparently blood tests catch everything, because I am sent home with a clean bill of health.

Surprisingly my mother does not laugh at me. We even get ice cream on the drive back. Then she says, “See, I know how you are, Kavya. Not every little thing is cancer.” And to be honest, I am glad she is right. I am not ready for the level of commitment that death requires.

** *

          Today my mother’s brother calls with good news. The shaman he visited yesterday

evening said that if Shreyas survives until November, then he will survive for another fifty years. My uncle means well, but he is too fervent. I want to tell him there is no God. I wonder if this will upset him. Moreover, what no one seems to understand is that Shreyas will likely have died by November. So the shaman’s advice, if true, is as true as it is irrelevant.

I do not tell my mother this. I just raise my eyebrows, so she says, “In desperate times we must exhaust every measure.”

My father says, “I do not believe in this either, Kavya. But I do believe in Shreyas. He is older than most of the other kids with this cancer, so he is also stronger. He will beat it.” Then he gets louder. “What? You do not believe me? You think he will die? How can you think that?” He looks ready to cry, so I walk into my sister’s room.

I know he is projecting his love for my sister onto Shreyas. All parents have favorites. She is his. They have the same sloping cheekbones and dark skin, so this makes sense.

Later, because I have to talk to someone, I tell my sister that our father is a mess, that he is supremely irrational. I tell her that, even worse, he expects us to be the same. She agrees, but then again, she will agree with anything to avoid conflict.

So I ask her, does Shreyas know what his cancer is called?

It turns out that she does not know what it is called either. So I tell her that too. Then I leave, knowing she will Google it the moment I shut the door. My heart is buzzing. I feel delightfully dirty.

** *

          A few months later, when I am back in college, my sister informs me that no, Shreyas does not know. Apparently he never asks about his cancer, and his parents do not tell him. He does not even Google his symptoms.

Then she says the Bhatts came over for dinner last weekend. They decided to watch The Maze Runner afterward, but Shreyas started crying when the Flare was introduced. He said it was because his mother always cried about his brain disease, and he did not like it when she cried. So I guess he knows it is bad, at least. And when you are living through it, there is no point in knowing any more.

His parents have lost all hope. They bought his Christmas present two months early. It is a Chinese Water Dog, like what the Obamas have. They had to drive hundreds of miles down to Bakersfield to pick it up. They already have an attention-starved beagle named Kevin, but their dying son had wanted one more, and how could they say no? Kevin is pissed as hell about it. He has been pulling Raj’s shoes off the rack and shitting into them.

I wonder if Shreyas has lost hope too, and if the dog has anything to do with it.

Now a rushing noise is filling my ears. The thing is, when the patient loses hope, that is it. Lights out, literally. But I need Shreyas to hang on until Christmas, when I am home. I know the reason why is not nice. I know it is wrong. But at least I can admit it: I want to watch him die, so that I can feel it too.


– Chinmayi Manjunath

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